Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India

Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+) intervention of community mobilization strategy providing conditional cash transfers (CCT) to women’s SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3%) women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5%) received ANC in the SCIL+ arm ( ); 175 (97%) in the SCIL and 366 (98.6%) in the SCIL+ arm consented to HIV testing ( ). HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women’s microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages. 1. Introduction Almost three decades after the first HIV antibody test, the vast majority of pregnant women in middle and low income countries are still not being tested for HIV as part of their antenatal care [1]. According to the United Nations Population Division, only about 26% of 125 million pregnant women in these countries learn their HIV status prior to delivery [2]. Not only is this knowledge essential to the initiation of prevention of mother-to-child transmission (PMTCT) of HIV services, but also it is an important gateway to antiretroviral therapy for HIV infected mothers and children [3]. Despite widespread scale-up of HIV prevention and PMTCT interventions, uptake of services remains low because a majority of HIV-positive pregnant women continue to be unaware of their status. Unsurprisingly, the group with least access to HIV testing remains rural and poor women who are more vulnerable to infection and less able to access needed services [4]. India is among the top ten countries in the world with the highest burden of pediatric HIV infections [5]. Of 27 million women giving birth each year, only 6 million are tested for HIV [6]. Those with least access to prevention services live in the country’s 600,000 rural villages. In a 2011 study, only 9% of