Tailored, one-on-one counseling delivered via cell phone was very effective in retaining mothers with HIV in care and in promoting infant HIV testing and antenatal and postnatal care attendance. The highest risk of loss to follow-up among women with HIV accessing PMTCT services was prior to delivery and then after infant HIV testing at 6 weeks. Challenges include continued limited access to cell phones, difficulty with reaching participants on the phone, and poor adherence to antiretroviral therapy for a substantial percentage of the population.

IntroductionIndia is home to over 6 million women’s groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women’s and children’s health.MethodsWe did a mixed-methods systematic review of quantitative and qualitative studies on women’s groups in India to examine effects on women and children’s health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women’s group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics.FindingsWe screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women’s groups can improve perinatal practices, neonatal survival, immunisation rates and women’s and children’s dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities’ capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints.ConclusionInterventions with women’s groups can improve women’s and children’s health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities’ capabilities.Trial registration numberThe review was registered with PROSPERO: CRD42019130633.

To assess the prevalence and correlates of perinatal depression, 200 HIV-positive pregnant/post-partum women receiving antiretroviral therapy (ART) were interviewed at eight government ART centers in four states across India. 52.5% (105) participants had depressive symptomology (Edinburgh Postnatal Depression Scale score > 13) while 23% of the participants reported thoughts of self-harm; there was no difference between pregnant and postpartum participants. Poor illness perception was associated with depression (AOR, 1.09; 95%CI, 1.05, 1.14); there was no association between adherence and depression in this population.

Objective: To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. Design: A crossover randomized controlled trial in four sites. Setting: Government ART centres (ARTCs) offering core services in the greater Mumbai area. Participants: Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. Intervention: Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. Main outcome measure: HIV stigma, measured using the 16-item Berger Stigma scale. Methods: The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. Results: At baseline, 57% of participants had moderate-high levels of stigma (scores >40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: β coeff = −9.71; p < 0.001; group intervention: β coeff = −5.22; p < 0.001; individual counselling: β coeff = −4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (β coeff = −10.29; p < 0.001), followed by GI+CA+IC (β coeff = −8.23, p < 0.001). Conclusion: Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program