Philani Plus (+): A Mentor Mother Community Health Worker Home Visiting Program to Improve Maternal and Infants’ Outcomes

Abstract

Pregnant mothers in South African townships face multiple health risks for themselves and their babies. Existing clinic-based services face barriers to access, utilization, and human resource capacities. Home visiting by community health workers (CHW) can mitigate such barriers. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting intervention program for maternal and child nutrition by integrating content and activities to address HIV, alcohol, and mental health. Pregnant Mothers at Risk (MAR) for HIV, alcohol, and/or nutrition problems in 24 neighborhoods in townships in Cape Town, South Africa (n=1,239) were randomly assigned by neighborhood to an intervention (Philani Plus (+), N=12 neighborhoods; n=645 MAR) or a standard-care control condition of neighborhood clinic-based services (N=12 neighborhoods; n=594 MAR). Positive peer deviant “Mentor Mother” CHWs are recruited from the township neighborhoods and trained to deliver four antenatal and four postnatal home visits that address HIV, alcohol, nutrition, depression, health care regimens for the family, caretaking and bonding, and securing government-provided child grants. The MAR and their babies are being monitored during pregnancy, 1 week post-birth, and 6 and 18 months later. Among the 1,239 MAR recruited: 26% were HIV-positive; 27% used alcohol during pregnancy; 17% previously had low-birthweight babies; 23% had at least one chronic condition (10% hypertension, 5% asthma, 2% diabetes); 93% had recent sexual partners with 10% known to be HIV+; and 17% had clinically significant prenatal depression and 42% had borderline depression. This paper presents the intervention protocol and baseline sample characteristics for the “Philani Plus (+)” CHW home-visiting intervention trial.

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

“…l 37 trials reporting a universal preventive intervention 61,123,129,146,147,150,[153][154][155][156][157][180][181][182][183][184][185][186][187][197][198][199][200][207][208][209][210][211][212][217][218][219][220][225][226][227][228] l 20 trials reporting a selective preventive intervention 149,[158][159][160][161][162][163][188][189][190][191][192][201]…”

Behavioral interventions to promote condom use among women living with HIV: a systematic review update

“…The difference in means (MD) and respective 95%CI were used to measure the absolute difference between the means in interventions and comparison groups. Since one included study was a cluster randomized trial, we used values of the intra-class correlation coefficient reported in a previous publication related to this intervention 34 to adjust trial analysis for clustering and enter its adjusted values in the meta-analysis. Consistent condom use (dichotomous outcome) was estimated using intention-to-treat analysis and included all subjects who were randomized, regardless of baseline condom use behavior.…”

Development and Evaluation of a Perinatal Service Delivery Web Platform for Prenatal Care Coordinators (Preprint)

“…Research shows that interventions beyond the clinic, utilizing mobile MHWs can become expensive. But, with efficiently deployed technologies and well-trained MHWs, home visit interventions can be beneficial and cost effective [7,24]. Mishandled deployment and narrow capabilities of MHWs can cause increases in costs of home visits up to twice that of clinical visits [7].…”