Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study

Abstract

Background Option B+ is a comprehensive antiretroviral treatment (ART) designed for HIV-infected pregnant/ postpartum women. However, barriers to implementing Option B+ and establishing long-term ART adherence while facilitating retention in prevention of mother to child transmission of HIV (PMTCT) services remain. Community-based mentor mothers (cMMs) who can provide home-based support for PMTCT services may address some of the barriers to successful adoption and retention in Option B+. Thus, we evaluated the acceptability of using cMMs as home-based support for PMTCT services. Methods Gender-matched in-depth interviews were conducted between September–November 2014 for HIV-infected pregnant/postpartum women and their male partners living in southwestern Kenya ( n = 40); additionally, we conducted four focus groups involving 30 health workers ( n = 70) within four health facilities. Audio-recordings were transcribed, translated, and then coded using a thematic analytical approach in which data were deductively and inductively coded with support from prior literature, identified themes within the interview guides, and emerging themes from the transcripts utilizing Dedoose software. Results Overall, the study results suggest high acceptability of cMMs among individual participants and health workers. Stigma reduction, improvement of utilization of health care services, as well as ART adherence were most frequently discussed potential benefits of cMMs. Participants pictured a cMM as someone acting as a role model and confidant, and who was over 30 years old. Many respondents raised concerns about breaches of confidentiality and inadvertent disclosure. Respondent suggestions to overcome these issues included the cMM working in different communities than where she lives and attending home-visits with no identifying clothing as an HIV-related health worker. Conclusions The home-based cMM approach may be a beneficial and acceptable strategy for promoting ART adherence and retention within PMTCT services for pregnant/postpartum women living with HIV. Considering the risks of inadvertent disclosure of HIV-infected status and related negative consequences for pregnant/postpartum women living with HIV, similar cMM program designs may benefit from recognizing and addressing these risks. Trial registration The MOTIVATE! study was registered on July 7, 2015 at the ClinicalTrials.gov ( NCT02491177 ). Electronic supplementary material The online version of this article (10.1186/s12884-019-2419-z) contains supplementary material, which is available to authorized users.

Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

“…Our findings suggest that future interventional studies to further increase partner disclosure among women in PMTCT care, such as counselling in support groups [48] or community interventions [49], should consider focusing on women ≥25 years and women diagnosed with HIV during the past 6 months. Therefore, continued counselling at routine follow-up visits could support and empower women in this effort, helping reduce concerns about isolation or lack of support from family and friends as well as concerns about conflict and separation from a partner.…”

“…Therefore, continued counselling at routine follow-up visits could support and empower women in this effort, helping reduce concerns about isolation or lack of support from family and friends as well as concerns about conflict and separation from a partner. Counselling could, for example, involve peer-support [2,49] and discussing what to do in worstcase scenarios.…”

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

“…Other studies have shown that peer‐centred approaches can effectively be combined with other interventions [72] and encourage other reproductive health behaviours [73]. These trial findings are largely supported by qualitative research, which confirm the overall feasibility and acceptability of the intervention [74‐76], including among adolescents [77]. For widespread implementation, however, adaptations may be required to fully optimize the role of peer supporters within the health system [78].…”

Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

“…The research team followed a rigorous protocol to ensure the consistency and validity of coding during the qualitative analysis, although a formal inter-rater reliability statistic was not computed. We used an iterative process of discussions with co-authors and research team members to develop initial codes that were then reconciled into an agreed coding framework and subsequently applied to the data in the final analysis [ 31 , 32 , 33 ]. This approach has also been used in multiple studies of quality improvement in sub-Saharan Africa [ 32 , 33 ].…”

“…We used an iterative process of discussions with co-authors and research team members to develop initial codes that were then reconciled into an agreed coding framework and subsequently applied to the data in the final analysis [ 31 , 32 , 33 ]. This approach has also been used in multiple studies of quality improvement in sub-Saharan Africa [ 32 , 33 ]. Coding was primarily conducted by two researchers, including one Malawian researcher, and the Malawi based research team (the principal investigator and site research staff) offered feedback via participation in debriefing sessions.…”