Background: In Malawi, Option B+ has increased the number of HIV-positive pregnant women and new mothers (PWNM) on antiretroviral therapy (ART). However, attrition from prevention of mother-to-child transmission (PMTCT) services endangers infants and mothers. Economic strengthening (ES) interventions can address structural barriers to PMTCT, but there is limited information on how to tailor ES activities for this population. We used financial diaries (FDs) to understand the economic lives of women in PMTCT to recommend appropriate ES interventions.
Methods: We collected quantitative FD data from a stratified sample (n=238) of HIV-positive PWNM enrolled in PMTCT from three clinics in Zomba, Malawi. For 30 weeks, participants met weekly with staff to record cash and in-kind inflows and outflows. Women also completed intake and exit surveys, which collected demographic, economic, PMTCT, and social support information. All quantitative data were compiled and summarized using R.
Results: For PWNM in Zomba, daily expenses were small but consistent; inflows came at sporadic intervals but were generally larger. The median number of weekly cash outflows per participant was 10, and the median value for outflow transactions was US$0.41. The majority (81%) of cash expenses were on food/drink. Of all cash expenditures, 8% were self-reported as PMTCT-related, with most categorized as food/drink. Participants had a median of 1 weekly inflow, and the median value of inflow transactions was US$3.42. The primary source of cash inflows was gifts (46%), with earnings from work accounting for only one-quarter of cash inflows as the second largest source. Over time, cash outflows remained relatively constant, while cash income began to increase when the rainy season brought more work opportunities.
Conclusions: PWNM control very small amounts of cash; weekly imbalances of cash inflows to outflows were common. The reliance on gifts rather than economic activity and the high proportion of expenses spent on food indicate a cash-poor population. PMTCT-related costs were a modest portion of total cash outflows but highlight the importance of sufficient quantities of nutritious foods for PMTCT success. PWNM would benefit from ES interventions centered on food support or income generating activities in the agriculture sector.