Assessing the Acceptability of a Peer Mentor Mother Intervention to Improve Retention in Care of Postpartum Women Living with HIV

Akinde, Yetunde; Groves, Allison K.; Nkwihoreze, Hervette; Aaron, Erika; Alleyne, Gregg; Wright, Charmaine; Jemmott, John B.; Momplaisir, Florence

doi:10.1089/heq.2019.0027

Cited by 9 publications

(13 citation statements)

References 18 publications

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“…Similar ndings have been reported from Kenya [14], and among low-income women in the United States [25], and England [26]. A recurring phrase in our study was that MMs 'were in the same shoes' as their WLHIV clients.…”

Section: Discussionsupporting

confidence: 89%

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Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Odiachi¹,

Al-Mujtaba

Torbunde

et al. 2021

Preprint

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Background: Mentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria.Methods: We conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected.Results: Most participants were female (n=78, 67%), and married (n=110, 94%). All participant groups found MMs acceptable, as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers’ services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers.Conclusions: Mentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention. Trial registration: Clinicaltrials.gov registration number NCT 01936753, registered on September 3, 2013 (retrospectively registered).

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Section: Discussionsupporting

confidence: 89%

“…A recurring phrase in our study was that MMs 'were in the same shoes' as their WLHIV clients. This similarity of lived experiences and personal demonstration of successful PMTCT outcomes make MMs relatable, credible role models [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Odiachi¹,

Al-Mujtaba

Torbunde

et al. 2021

Preprint

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“…Our previous analysis demonstrated the role that anticipated stigma played as a barrier to PrEP initiation and persistence in our cohort [31]. Future interventions should address stigma, especially anticipated stigma, including mentor mother or peer based programs to share how women countered stigma and negativity in their community [32].…”

Section: Discussionmentioning

confidence: 73%

“I had Made the Decision, and No One was Going to Stop Me” —Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa

et al. 2021

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PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of long-term maternal adherence are not well understood. We conducted semi-structured interviews with 25 postpartum women who reported high adherence (PrEP use ≥ 25 days in last 30-days and never missed a PrEP prescription in pregnancy/postpartum period) within a PrEP service for pregnant and postpartum women. A thematic approach guided an iterative process of coding and analysis. Themes identified as drivers of optimal PrEP use were HIV risk perception, mainly because of partner's behaviors and unknown serostatus, and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use facilitated PrEP adherence. Women discussed having partner and family support, which included reminders to take PrEP daily. Primary barriers were anticipated or experienced stigma, overcome through education of partners and family about PrEP. Pregnant women experienced transient side-effects, but found ways to continue, including taking PrEP at night. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for disclosure and securing support from significant others.

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“…[27] Our previous analysis demonstrated the role that anticipated stigma played as a barrier to PrEP initiation and persistence in our cohort[28]. Future interventions should address stigma, especially anticipated stigma, including mentor mother or peer based programs to share how women countered stigma and negativity in their community [29].…”

Section: Discussionmentioning

confidence: 99%

“I had made the decision, and no one was going to stop me” —Facilitators of PrEP adherence during pregnancy and postpartum in Cape Town, South Africa

Davey

Knight

Markt-Maloney

et al. 2020

Preprint

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IntroductionHIV incidence is high during pregnancy and postpartum in many settings. PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of high maternal adherence are not well understood in high HIV burden settings.MethodsWe conducted semi-structured interviews with women who reported high adherence (PrEP use ≥ 25 days in last 30-days) within a PrEP service for pregnant and postpartum women located in a large primary care facility in a high-HIV burden township. Topics for interviews included: individual/interpersonal risk, disclosure, anticipated PrEP stigma, safety, side-effects, and facility-level factors effecting adherence. A thematic approach guided an iterative process of coding (reviewed to ensure intercoder reliability) and analysis using NVivo 12.ResultsWe interviewed 25 postpartum women with high PrEP adherence who were on PrEP for a median of 9-months, median age 26-years, and median baseline gestational age 24-weeks. Themes identified as key drivers of optimal PrEP use were HIV risk perception – primarily due to partner’s perceived risky sexual behaviors and unknown serosatus—and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use to family, partners and friends facilitated PrEP adherence. Women continued PrEP postpartum because they felt empowered by PrEP and did not want to “go backwards” and increase their HIV risk as before PrEP. Women who reported high adherence all discussed having community support and reminders to take PrEP on time. The primary barriers were anticipated or experienced stigma, which most overcame through education of partners/family about PrEP. Pregnant women experienced transient side effects, but found ways to continue, including taking PrEP at night. Women believed PrEP education and counselling were accessible when integrated into antenatal care which contributed to continued PrEP use.ConclusionsFacilitators of optimal PrEP use through pregnancy and postpartum included fear of HIV acquisition for self and infant, mostly due to partner sexual behaviors and unknown serostatus, along with PrEP disclosure, and encouragement from partners and family. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for securing support for significant others.

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Assessing the Acceptability of a Peer Mentor Mother Intervention to Improve Retention in Care of Postpartum Women Living with HIV

Cited by 9 publications

References 18 publications

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

“I had Made the Decision, and No One was Going to Stop Me” —Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa

“I had made the decision, and no one was going to stop me” —Facilitators of PrEP adherence during pregnancy and postpartum in Cape Town, South Africa

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