Realities and Challenges of a Five Year Follow Up of Mother and Child Pairs on a PMTCT Program in Zimbabwe

Kurewa, Edith Nyaradzai; Kandawasvika, Gwendoline; Mhlanga, Felix; Munjoma, Marshall; Mapingure, Munyaradzi; Chandiwana, Panashe; Chirenje, Mike; Rusakaniko, S; Stray‐Pedersen, Babill

doi:10.2174/1874613601105010051

Cited by 45 publications

(49 citation statements)

References 25 publications

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“…Because standardized definitions for LTFU were not available, the EPAZ team decided to work with 2 indicators, namely "Retention" and "Level of Retention" that were defined for the study (Table 1). 10 …”

Section: Study Objectives and Formative Researchmentioning

confidence: 99%

Cluster Randomized Trial on the Effect of Mother Support Groups on Retention-in-Care and PMTCT Outcomes in Zimbabwe

Foster¹,

Kangwende²,

Magezi³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Prevention of mother-to-child transmission (PMTCT) elimination goals are hampered by low rates of retention and antiretroviral treatment adherence. The Eliminating Pediatric AIDS in Zimbabwe (EPAZ) project is assessing whether mother support groups (MSGs) increase rates of retention-in-care of HIV-positive mothers and their exposed infants, increase male participation, and improve other maternal and infant health outcomes. EPAZ is a cluster randomized study involving 30 rural facilities in 2 health districts in Mutare province in eastern Zimbabwe. Facilities were randomly assigned to either the standard-of-care or intervention arms. We established MSGs for HIV-positive mothers at the 15 health facilities in the intervention arm. MSGs met every 2 weeks and were led by an HIV-positive mother who was appointed as MSG coordinator (MSG-C). MSG-Cs contacted nonattending patient-members of support groups by cell phone. If members still do not attend, MSG-Cs inform a health worker who initiates further outreach actions that are standard within the health system. At least 10 HIV-positive mothers are enrolled per facility. Enrollment started in July 2014. The primary outcome measure is retention-in-care of HIV-exposed infants at 12 months of age. Secondary outcome measures are: retention-in-care of HIV-positive mothers at 12 months postpartum, male participation, and other maternal and child health indicators. The study relies on routine health system data supplemented by additional data using tools created for the study. If shown to improve PMTCT retention outcomes, facility-based MSGs have the potential to be scaled up throughout the Zimbabwe National PMTCT program and could be considered in other country programs.

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Section: Study Objectives and Formative Researchmentioning

confidence: 99%

Cluster Randomized Trial on the Effect of Mother Support Groups on Retention-in-Care and PMTCT Outcomes in Zimbabwe

Foster¹,

Kangwende²,

Magezi³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…For example, investments have been made for greater operational research on improving large-scale malaria, malnutrition, and HIV interventions. [48][49][50] Specific tools necessary for research pursuits include advanced degrees and training in epidemiology, biostatistics, and ethics. These skills may be obtained through graduate-level coursework and field-based experience with appropriate mentorship.…”

Section: Global Health Researchmentioning

confidence: 99%

Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors

Nelson¹,

Kasper²,

Hibberd³

et al. 2012

Journal of Graduate Medical Education

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Background Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health. Objective Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health. Methods We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors. Conclusions A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.

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“…The existing literature shows that a large percentage of women are lost along this cascade [12]. While the evidence on postpartum retention is sparse, depending on the setting and follow-up period, approximately 25–50% of women on ART at delivery may be lost from care during the postpartum period [13–15]. This high attrition rate is problematic due to the increased risks of HIV-related morbidity and mortality, HIV transmission, and the development of drug-resistant HIV strains [16,17].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

Geldsetzer

Yapa

Vaikath

et al. 2016

Journal of the International AIDS Society

109

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IntroductionThe World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes.MethodsWe searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria.Results and DiscussionAfter screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way.ConclusionsOverall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum.

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Realities and Challenges of a Five Year Follow Up of Mother and Child Pairs on a PMTCT Program in Zimbabwe

Cited by 45 publications

References 25 publications

Cluster Randomized Trial on the Effect of Mother Support Groups on Retention-in-Care and PMTCT Outcomes in Zimbabwe

Cluster Randomized Trial on the Effect of Mother Support Groups on Retention-in-Care and PMTCT Outcomes in Zimbabwe

Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors

A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

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