Effectiveness of a Lay Counselor–Led Combination Intervention for Retention of Mothers and Infants in HIV Care: A Randomized Trial in Kenya

Fayorsey, Ruby; Wang, Chunhui; Chege, Duncan; Reidy, William; Syengo, Masila; Owino, Samuel O.; Koech, Emily; Sirengo, Martin; Hawken, Mark; Abrams, Elaine J.

doi:10.1097/qai.0000000000001882

Cited by 20 publications

(36 citation statements)

References 32 publications

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“…This indicates that combination prevention including UTT can make a substantial contribution to HIV epidemic control. Importantly, the effects seen in our study, Ya Tsie study and others 28 were achieved by delivering intensive household-based HIV-testing services; this may have played a more important role than changes in ART guidelines. The universal “test” component of a “test-and-treat” strategy is vital, as is continued attention to primary HIV prevention interventions.…”

Section: Discussionmentioning

confidence: 58%

Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

et al. 2019

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Background Universal testing and treatment (UTT) is a potential strategy to reduce HIV incidence, yet prior trial results are inconsistent. We report results from HPTN 071 (PopART), the largest HIV prevention trial to date. Methods In this community-randomized trial (2013-18), 21 communities in Zambia and South Africa were randomized to Arm A (PopART intervention, universal antiretroviral therapy [ART]), Arm B (PopART intervention, ART per local guidelines), and Arm C (standard-of-care). The PopART intervention included home-based HIV-testing delivered by community workers who supported linkage-to-care, ART adherence, and other services. The primary outcome, HIV incidence between months 12-36, was measured in a Population Cohort (PC) of ~2,000 randomly-sampled adults/community aged 18-44y. Viral suppression (VS, <400 copies HIV RNA/ml) was measured in all HIV-positive PC participants at 24m. Results The PC included 48,301 participants. Baseline HIV prevalence was similar across study arms (21%-22%). Between months 12-36, 553 incident HIV infections were observed over 39,702 person-years (py; 1.4/100py; women: 1.7/100py; men: 0.8/100py). Adjusted rate-ratios were A vs. C: 0.93 (95%CI: 0.74-1.18, p=0.51); B vs. C: 0.70 (95%CI: 0.55-0.88, p=0.006). At 24m, VS was 71.9% in Arm A; 67.5% in Arm B; and 60.2% in Arm C. ART coverage after 36m was 81% in Arm A and 80% in Arm B. Conclusions The PopART intervention with ART per local guidelines reduced HIV incidence by 30%. The lack of effect with universal ART was surprising and inconsistent with VS data. This study provides evidence that UTT can reduce HIV incidence at population level. Trial registration ClinicalTrials.gov NCT01900977

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Section: Discussionmentioning

confidence: 58%

Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

et al. 2019

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“…We found 37 papers examining an approach to increase maternal retention in antenatal and/or postpartum care in samples that included adolescent and young WLHIV. Notably, only two papers presented age-disaggregated results [26,27] and one additional paper noted that age did not modify the study results [28]. Among all 37 papers evaluating at least one approach to increase retention, 18 demonstrated no effect on retention [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 19 reported a significant effect on retention [26][27][28][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62].…”

Section: Resultsmentioning

confidence: 99%

“…Notably, only two papers presented age-disaggregated results [26,27] and one additional paper noted that age did not modify the study results [28]. Among all 37 papers evaluating at least one approach to increase retention, 18 demonstrated no effect on retention [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 19 reported a significant effect on retention [26][27][28][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Notably, several papers reported significant improvements in retention at some time points but not at others; these are categorized as reporting a significant effect on retention.…”

Section: Resultsmentioning

confidence: 99%

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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Introduction: Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. Methods: Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported agedisaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. Results and discussion: Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. Conclusions: This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/ or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.

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“…The MIR4Health study, for example deployed trained lay counsellors to provide pregnant women with coordinated support, including individualized health education, retention/adherence support, phone and SMS appointment reminders and missed visit tracking. Women in the intervention arm had lower rates of attrition by six months postpartum when compared to the standard of care (18.8% vs. 28.2%, relative risk: 0.67, 95% CI: 0.45 to 0.99) [79].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

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Effectiveness of a Lay Counselor–Led Combination Intervention for Retention of Mothers and Infants in HIV Care: A Randomized Trial in Kenya

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 20 publications

References 32 publications

Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

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

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