Background For pregnant or breastfeeding HIV-positive women, poor adherence to antiretroviral (ARV) medication and disengagement from care can increase risk of mother-to-child transmission of HIV. HIV-positive women exhibiting high temporal discounting (TD; defined as the tendency to discount future rewards relative to rewards received closer to the present) may be less likely to adhere to recommendations for the prevention of mother to child transmission (PMTCT).

Methods We performed a secondary analysis of data from a randomized controlled trial conducted in the Democratic Republic of Congo, which assessed the effects of a conditional cash transfer intervention among 433 newly-diagnosed HIV-infected pregnant women. We measured TD at baseline using a delay discounting task. We dichotomized TD (high/low) and examined associations between TD and uptake of available PMTCT services, retention in care and viral suppression at 6 weeks postpartum. We used log-binomial regression models to calculate unadjusted and adjusted risk ratios (RRs) for the effects of high vs. low TD on these outcomes.

Results At baseline, participants had a median age of 29 years, median of 10 years of education, and median gestational age of 26 weeks. The majority (86.6%) of women exhibited high TD, where 13.4% exhibited low TD. High TD was associated with incomplete uptake of PMTCT services (adjusted RR: 1.64, 95% confidence interval (CI): 1.08–2.50) and lower viral suppression at 6 weeks postpartum (adjusted RR: 0.77, 95% CI: 0.66–0.90). Temporal discounting was not associated with retention to care in unadjusted (RR: 1.57 95% CI: 0.78–3.15) or adjusted analyses (RR: 1.56, 95% CI: 0.76–3.18).

Conclusion Understanding the mechanisms underlying women’ behavioral choices is crucial to optimize interventions for behavior change. Our results indicate that women exhibiting high temporal discounting represent a critical population for interventions to improve adherence and engagement in PMTCT care.

Disclosure No significant relationships.