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Open Access Debate

Improving utilization of and retention in PMTCT services: Can behavioral economics help?

Nicholas Kenji Taylor1* and Alison M Buttenheim2

Author Affiliations

1 Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA

2 University of Pennsylvania School of Nursing, Room 235L Fagin Hall, 418 Curie Blvd, Philadelphia, Pennsylvania 19104, USA

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BMC Health Services Research 2013, 13:406  doi:10.1186/1472-6963-13-406

Published: 10 October 2013

Abstract

Background

The most recent strategic call to action of the World Health Organization sets the elimination of pediatric HIV as a goal. While recent efforts have focused on building infrastructure and ensuring access to high-quality treatment, we must now turn our focus to the behavior change needed to eliminate vertical transmission. We make the case for the application of concepts from the field of behavioral economics to prevention of mother-to-child transmission (PMTCT) programs to more effectively address demand-side issues of uptake and retention.

Discussion

We introduce five concepts from the field of behavioral economics and discuss their application to PMTCT programs: 1) Mentor mothers who come from similar circumstances as PMTCT patients can serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment. 2) Economic incentives, like cell phone minutes or food vouchers, that reward adherence to PMTCT protocols leverage present bias, the observation that people are generally biased toward immediate versus future awards. 3) Default bias, our preference for the default option, is already being used in many countries in the form of opt-out testing, and could be expanded to all PMTCT programs. 4) We are hardwired to avoid loss more than to pursue an equivalent gain. PMTCT programs can take advantage of loss aversion through the use of commitment contracts that incentivize mothers to return to the clinic in order to avoid both reputational and financial loss.

Summary

Eliminating vertical transmission of HIV is an ambitious goal. To close the remaining gap, innovations are needed to address demand for PMTCT services. Behavioral economics offers a set of tools that can be engineered into PMTCT programs to increase uptake and improve retention with minimal investment.

Keywords:
Behavioral economics; Developing countries; Health behavior; Health promotion; HIV infections; Infectious disease transmission; Vertical; Maternal health services; Medication adherence; Patient acceptance of health care