Community-based approaches to prevention of mother-to-child transmission of HIV: Findings from a low-income community in Kenya

Abstract

The Horizons Program, in partnership with International Medical Corps (IMC) and Steadman Research Services International (SRSI), conducted an intervention study in Kibera, an urban slum in Nairobi, to determine what effect three different community-based activities had on utilization of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants (TBAs) and peer counselors as PMTCT promoters. Researchers used a pre-/post-test evaluation 4-cell design (three experimental intervention arms and a comparison arm with no additional community activities) to assess the outcomes of the pilot project. Each arm corresponded to a distinct sub-area of the Kibera slum. At baseline (June 2004), a total of 1,803 women took part in exit interviews at the clinics. In October and November 2004, researchers conducted in-depth interviews to further explore issues raised in the quantitative survey. The convenience sample included 24 HIV-positive women and five HIV-negative women with infants aged 10 weeks or younger. These women were selected from the four study arms. Interviews were conducted in Kiswahili, recorded, transcribed, and then translated into English.

Implementing Programs for the Prevention of Mother-to-Child HIV Transmission in Resource-Constrained Settings: Horizons Studies, 1999–2007

“…Moreover, continued implementation of routine testing at ANC sites with PMTCT programming can rapidly improve coverage. The proportion of postpartum women reporting that they took an HIV test at an ANC visit in Kenya increased from 84% to 93% between 2004 and 2005, 8 and in Swaziland, this figure rose from 72% to 92% between 2006 and 2007. 15 In India, nearly three-quarters of HIV-positive women interviewed underwent HIV testing as part of their ANC, suggesting that HIV testing during ANC is making a notable contribution toward HIV testing among women of reproductive age.…”

“…In Kenya, self-reports of infant feeding practices at six weeks postpartum among women who were HIV-positive, HIV-negative, and of unknown HIV status indicated that most women were using a mixed feeding method, in marked contrast to the infant feeding recommendations. 8 Improving utilization and impact By the early 2000s, PMTCT pilot programs were in place, but they were reaching only a small proportion of HIV-positive pregnant women. 5 Implementation of PMTCT services at their most basic included HIV counseling and testing to identify HIV-positive women during ANC, provision of ARV prophylaxis to HIV-positive women and their exposed infants, and infant feeding information.…”

“…10,23 High rates of disclosure by HIV-positive women As testing among pregnant women has increased, so has disclosure by HIV-positive women, the majority of whom report disclosing their HIV status to at least one individual. Horizons studies found that more than three-quarters of HIV-positive women surveyed in the Botswana, India, South Africa, Kenya, and Swaziland studies [8][9][10]15,18,19 reported disclosing their status to at least one individual, most commonly a partner or husband. This rate held constant despite wide differences in marriage rates in the study populations.…”

Looking back, moving forward: Implementing PMTCT programs in resource-constrained settings, Horizons studies 1999 to 2007

“…With increased testing among pregnant women, it has become more common for those women to reveal their HIV status to another person. Horizons studies found that more than three-quarters of HIVpositive women surveyed in Botswana, India, Kenya, South Africa, and Swaziland [9,10,16,21,26], reported telling at least one person, most commonly a partner or husband, they were HIV-positive. This held constant despite wide differences in marriage rates in the study populations.…”