Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania

Abstract

Peer support services are increasingly being integrated in programmes for the prevention of mother-to-child HIV transmission (PMTCT). We aimed to evaluate the effect of a peer-mother interactive programme on PMTCT outcomes among pregnant women on anti-retroviral treatment (ART) in routine healthcare in Dar es Salaam, Tanzania. Twenty-three health facilities were cluster-randomized to a peer-mother intervention and 24 to a control arm. We trained 92 ART experienced women with HIV to offer peer education, adherence and psychosocial support to women enrolling in PMTCT care at the intervention facilities. All pregnant women who enrolled in PMTCT care at the 47 facilities from 1st January 2018 to 31st December 2019 were identified and followed up to 31st July 2021. The primary outcome was time to ART attrition (no show >90 days since the scheduled appointment, excluding transfers) and any difference in one-year retention in PMTCT and ART care between intervention and control facilities. Secondary outcomes were maternal viral suppression (<400 viral copies/mL) and mother-to-child HIV transmission (MTCT) by ≥12 months post-partum. Analyses were done using Kaplan Meier and Cox regression (ART retention/attrition), generalized estimating equations (viral suppression) and random effects logistic regression (MTCT); reporting rates, proportions and 95% confidence intervals (CI). There were 1957 women in the peer-mother and 1384 in the control facilities who enrolled in routine PMTCT care during 2018–2019 and were followed for a median [interquartile range (IQR)] of 23 [10, 31] months. Women in both groups had similar median age of 30 [IQR 25, 35] years, but differed slightly with regard to proportions in the third pregnancy trimester (14% versus 19%); advanced HIV (22% versus 27%); and ART naïve (55% versus 47%). Peer-mother facilities had a significantly lower attrition rate per 1000 person months (95%CI) of 14 (13, 16) versus 18 (16, 19) and significantly higher one-year ART retention (95%CI) of 78% (76, 80) versus 74% (71, 76) in un-adjusted analyses, however in adjusted analyses the effect size was not statistically significant [adjusted hazard ratio of attrition (95%CI) = 0.85 (0.67, 1.08)]. Viral suppression (95%CI) was similar in both groups [92% (91, 93) versus 91% (90, 92)], but significantly higher among ART naïve women in peer-mother [91% (89, 92)] versus control [88% (86, 90)] facilities. MTCT (95%CI) was similar in both groups [2.2% (1.4, 3.4) versus 1.5% (0.7, 2.8)]. In conclusion, we learned that integration of peer-mother services in routine PMTCT care improved ART retention among all women and viral suppression among ART naïve women but had no significant influence on MTCT.

Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania

“…Finally, ART attrition was mainly due to the high LTFU of 32% in our cohort, mirroring previous studies from Tanzania and Malawi among women receiving lifelong ART [8,13,41]. While the routine data used lack information on the reasons for LTFU, Ugandan and South African studies that traced LTFU women found that a minority (36% vs. 38%) were receiving ART in other facilities [20,45].…”

“…The higher attrition rates observed in our study could be explained by long waiting times and inadequate services that may lead to reduced defaulter tracing. Task‐shifting using peer mothers can reduce clinic burden and improve ART counselling and retention [41]. ART outreach by community health workers also improves adherence and early defaulter tracing [42].…”

Perspectives and thoughts of pregnant women and new mothers living with HIV receiving peer support: A mixed studies systematic review

“…Three studies were conducted in South Africa (Hamilton et al., 2020; Richter et al., 2014; Rotheram‐Borus et al., 2014); two studies were conducted in Zimbabwe (Orne‐Gliemann et al., 2017; Shroufi et al., 2013), while one study each was conducted in the following regions: Malawi (Phiri et al., 2017), Mozambique (Carlucci et al., 2022), Nigeria (Odiachi et al., 2021), Tanzania (Lyatuu et al., 2022), Uganda (Namukwaya et al., 2015) and Zambia (Simpson et al., 2021). Four studies were conducted at healthcare‐based facilities (Lyatuu et al., 2022; Orne‐Gliemann et al., 2017; Richter et al., 2014; Rotheram‐Borus et al., 2014). There were two studies solely conducted at community‐based facilities (i.e., home) (Hamilton et al., 2020; Simpson et al., 2021).…”

“…However, mothers with peer-mother support services had a lower ART attrition rate and higher retention in the prevention of motherto-child HIV transmission and ART adherence (Lyatuu et al, 2022;McLeish & Redshaw, 2016;Odiachi et al, 2021;Phiri et al, 2017;Richter et al, 2014;Shroufi et al, 2013;Simpson et al, 2021). Higher retention of participants was found in peer-supported facility-based and peer-supported community-based models with peer-mother support services as compared to healthcare-based standards of care (Phiri et al, 2017).…”

“…Three studies were conducted in South Africa (Hamilton et al, 2020;Richter et al, 2014;Rotheram-Borus et al, 2014); two studies were conducted in Zimbabwe (Orne-Gliemann et al, 2017;Shroufi et al, 2013), while one study each was conducted in the following regions: Malawi (Phiri et al, 2017), Mozambique (Carlucci et al, 2022), Nigeria (Odiachi et al, 2021), Tanzania (Lyatuu et al, 2022), Uganda (Namukwaya et al, 2015) and Zambia (Simpson et al, 2021). Four studies were conducted at healthcare-based facilities (Lyatuu et al, 2022;Orne-Gliemann et al, 2017;Richter et al, 2014;Rotheram-Borus et al, 2014). There were two studies solely conducted at community-based facilities (i.e., home) (Hamilton et al, 2020;Simpson et al, 2021).…”