Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as “family planning champions” increases referrals and uptake of family planning among HIV-infected mothers

Abstract

BackgroundIn 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic.MethodsThe Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification and referral of HIV Positive mothers in need of FP services; and accompanied referred mothers to FP clinics. We compiled and compared the average proportions of mothers in need that were referred and took up FP in the pre-intervention (3 months), intervention (6 months), and post-intervention(3 months) periods using interrupted time series with segmented regression models with an autoregressive term of one.ResultsOverall, during the intervention, the proportion of referred mothers in need of FP increased by 30.4 percentage points (P < 0.001), from 52.7 to 83.2 percentage points. FP uptake among mothers in need increased by over 31 percentage points (P < 0.001) from 47.2 to 78.5 percentage points during the intervention. There was a positive non-significant change in the weekly trend of referral β3 = 2.9 percentage points (P = 0.077) and uptake β3 = 1.9 percentage points (P = 0.176) during the intervention as compared to the pre-intervention but this was reversed during the post intervention. Over 57% (2494) mothers took up Depo-Provera injectable-FP method during the study.ConclusionsTo support overstrained health care work force in post-natal clinics, peers in trained effective family planning can be a valuable addition to clinic staff in limited-resource settings. The study provides additional evidence on the utilization of peer mothers in HIV care, improves health services uptake including family planning which is a common practice in many donor supported programs. It also provides evidence that may be used to advocate for policy revisions in low-income countries to include peers as support staff especially in busy clinic settings with poor services uptake.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2386-x) contains supplementary material, which is available to authorized users.

Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study

“…Interventions that focus on efficient and acceptable delivery of comprehensive family planning counselling are needed, especially in high HIV-burden rural settings where health systems are relatively weaker and missed opportunities for PMTCT may be more likely. Delivery of these services could be expanded and sustained through trained community workers or lay peer mentors to overcome the relative lack of professional healthcare workers and inadequate counselling skills that often limit provision of family planning counselling to HIV-infected women [42, 44]. Of note, structured peer support provided by Mentor Mothers emerged as a negative correlate of reported condom use when compared with no contraception.…”

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

“…The PURE Malawi trial found that, compared to the prevailing standard of care, facility‐ and community‐based peer support models led to better uptake of ART (81% vs. 86% and 90% respectively) and retention at 24 months (66% vs. 80% and 83% respectively) [71]. 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].…”

‘We are not going anywhere’: a qualitative study of Kenyan healthcare worker perspectives on adolescent HIV care engagement during the COVID-19 pandemic

“… 37 38 Given observed gaps in adolescent access to sexual and reproductive healthcare and family planning, unplanned pregnancies, and experiences of stigma and mental health challenges, programmes can further train and leverage YPM to lead work with adolescents in these areas. 39–41 …”

“… 63 Urgent measures are needed to address the needs of adolescents, particularly for food access or assistance, financial interventions, and improved access to family planning and PMTCT care, including through YPM interventions. 39 41 67 Further research is needed to understand the full extent of impacts of the COVID-19 pandemic on the adolescent HIV care cascade and on perinatal HIV transmission. 22 68 …”