Evaluating a Conditional Cash Transfer Programme for Viral Suppression Among Pregnant and Postpartum Women with HIV in Zomba District, Malawi

Pregnant and postpartum women living with HIV are at increased risk of treatment interruption and poor viral suppression, endangering maternal health and efforts to eliminate vertical transmission. While conditional cash transfer programmes have improved health behaviours in other contexts, their effectiveness for this population in sub-Saharan Africa is not well documented. This brief report evaluated the effectiveness of a conditional cash transfer programme designed to improve viral suppression rates among pregnant and postpartum women with HIV in Zomba District, Malawi. A non-randomised, controlled intervention was implemented. Women in the intervention group received modest cash transfers conditional upon monthly clinic attendance and verified antiretroviral therapy collection. A comparison group received standard care. Viral load was measured at enrolment and six months postpartum for both groups. Preliminary analysis indicates a positive association between the cash transfer and viral suppression. At six months postpartum, a greater proportion of women in the intervention group achieved viral suppression (<1000 copies/mL) compared to the comparison group (78% versus 62%). The conditional cash transfer programme appears to be a feasible and potentially effective strategy for supporting viral suppression among pregnant and postpartum women with HIV in this setting. Further rigorous evaluation is warranted. Programme planners should consider piloting integrated economic support within antenatal and postnatal HIV services. Future research should employ randomised designs and include longer-term follow-up and cost-effectiveness analyses. Conditional cash transfer, viral suppression, postpartum, pregnancy, HIV, Malawi, economic intervention This brief report provides preliminary field evidence on the use of a conditional economic incentive to improve a key clinical outcome for a priority population within the prevention of mother-to-child transmission cascade.