Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe

Abstract

Objective Integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission (PMTCT) services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health. Study Design HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n=33) or intervention (n=65) cohort, based on study entry date, and followed for three months post-partum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge, and HIV disclosure, and were assessed with Fisher’s exact, binomial, and t-tests. Results The intervention cohort reported increased control over condom use (p=0.002), increased knowledge about IUDs (p=0.002), increased relationship power (p=0.01), and increased likelihood of disclosing their HIV status to a partner (p=0.04) and having that partner disclose to them (p=0.04), when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~2% at baseline to >80% at three months post-partum (p<0.001). Conclusions FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.

Increasing HIV serostatus disclosure in low and middle-income countries

“…All but one intervention either targeted only women or had a majority of female participants. Five interventions targeted pregnant women [32, 34, 35, 37, 41]; of these, four focused on HIV-positive pregnant women [32, 35, 37, 41], while one included both positive and negative women and their partners [34]. Six interventions targeted HIV-infected adults, including newly diagnosed people living with HIV (PLHIV) [31, 33], HIV-infected women [29, 40], people initiating ART [39], and adults living with HIV generally [36, 38].…”

“…There were three randomized controlled trials (RCTs) [34-36] and five additional studies that included control groups but did not randomize participants to the intervention [32, 37, 39-41]. One study used a cross-sectional design to compare individuals who received the intervention to those who did not [38], while three studies used a before/after design just among intervention participants [29, 30, 42].…”

“…Four studies provided multi-session support groups to pregnant women living with HIV [32, 35, 37, 41]. Of these, the Mamekhaya intervention additionally provided “mother mentors” – HIV positive mothers trained as positive role models [32], while the PURSE study was part of a larger effort to integrate family planning into prevention of mother-to-child transmission (PTMCT) services [41].…”

“…Of these, the Mamekhaya intervention additionally provided “mother mentors” – HIV positive mothers trained as positive role models [32], while the PURSE study was part of a larger effort to integrate family planning into prevention of mother-to-child transmission (PTMCT) services [41]. Although all four studies included control groups, they shared some other limitations: three had significant attrition, only one randomized women to the intervention, and only one reported that intervention and control groups had comparable rates of disclosure at baseline (Table 2).…”

“…Although all four studies included control groups, they shared some other limitations: three had significant attrition, only one randomized women to the intervention, and only one reported that intervention and control groups had comparable rates of disclosure at baseline (Table 2). Two of the four studies found that the intervention significantly increased disclosure: a study conducted in South Africa found that, compared to control participants, intervention participants had 8.3 times the odds of disclosure to anyone (95% CI: 2.1-32.9)[37], while the family planning/PMTCT integration study found that 98.4% of women intervention participants had disclosed to their partners by 3 months post-partum compared to 87.5% of control group women (p=0.04) [41]. The other two studies found no statistically significant effect on disclosure [32, 35].…”