Acceptability and feasibility of a peer-support, ‘Mentor Mother’ program in Gaza, Mozambique

Abstract

Background To increase retention in prevention of mother-to-child transmission programs, Mozambique launched a peer-support program in 2018, where HIV-positive mothers provide support as mentor mothers (MMs) by conducting home visits for HIV-positive pregnant and lactating women and HIV-exposed and infected children. Methods A qualitative evaluation was conducted across nine facilities in Gaza Province to assess the barriers, facilitators, and acceptability of the mentor mother program (MMP) among those receiving services and those providing services. In-depth interviews and focus group discussions were conducted with MMs, MM supervisors, health care workers (HCWs), HIV-positive mothers enrolled in the MMP, HIV-positive mothers who refused MMP enrollment, and key informants involved in the implementation of the program. Thematic content analysis identified emerging recurrent themes and patterns across the participants’ responses. Results The MMP was well received by HIV-positive women enrolled in the MMP, MMs providing services, and HCWs at the facilities. HIV-positive women reported that counseling from MMs improved their understanding of why anti-retroviral treatment (ART) adherence was important and how they should take their ART. HIV-positive mothers enrolled in the MMP reported having reduced guilt and shame about their HIV-status, feeling less alone, less isolated, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. Additionally, MMs felt extremely satisfied having an impact on others’ lives. However, MMs also reported feeling that they had inadequate resources to perform job functions and listed inadequate transportation, insufficient stipends, and false address reports from HIV-positive mothers to the health facilities among their constraints. Overall, HCWs felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. Conclusions This study demonstrated that the MMP provided substantive and highly valued support to HIV-positive women, resulting in increased client understanding of ART’s purpose and administration as well as improved self-reported well-being and sense of community and reduced feelings of isolation. Recommendations include strengthening MM training and provision of resources, additional information provided to newly enrolled mothers and support for the male partners.

Gender and stigma in antiretroviral treatment adherence in Mozambique: A qualitative study

“…ART adherence under stigma is a negotiation influenced by the prevailing gender norms and economic constraints, therefore interventions aiming to improve adherence will need to take into account the power dynamics of the social structures and their interaction with stigma. In contexts where the gender dynamic is a pertinent driver of HIV stigma, some interventions have proven to enhance treatment adherence based on sensitivity on the existing gender roles, such as women’s role in reproduction and child care [ 43 , 44 , 70 ]. Joint testing of partners in antenatal care can help avoid the discussion and potential conflict over who had the infection first.…”

“…In addition, specific cadres of community health workers to support those at highest risk of defaulting were deployed by partner NGOs. These cadres included mentor mothers addressing specific support needs of pregnant and breastfeeding women [ 43 , 44 ] and lay extension workers called activistas making calls and home visits to men and non-pregnant women missing their appointments [ 45 ]. In 2020 the activistas and mentor mothers managed to bring back to care 84% of patients assigned to them [ 46 ].…”