The Impact of Structured Mentor Mother Programs on Presentation for Early Infant Diagnosis Testing in Rural North-Central Nigeria: A Prospective Paired Cohort Study

Sam-Agudu, Nadia A.; Ramadhani, Habib O.; Isah, Christopher; Erekaha, Salome; Fan-Osuala, Chinenye; Anaba, Udochisom; Adejuyigbe, Ebunoluwa A.; Charurat, Manhattan

doi:10.1097/qai.0000000000001345

Cited by 41 publications

(46 citation statements)

References 17 publications

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“…Furthermore, given the median gestational age at booking and at delivery of 20 and 36 weeks respectively, the period of time between MM-client engagement and delivery was relatively short and may not have allowed for enough time for the MM interventional peer support to establish outcomes that would be significantly different from that of routine support. Detailed analyses of the impact of postpartum peer support on MoMent’s primary and key secondary outcomes have been published elsewhere [16, 17]. …”

Section: Discussionmentioning

confidence: 99%

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Sam-Agudu

Isah

Fan-Osuala

et al. 2017

BMC Pregnancy Childbirth

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BackgroundLow rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants.MethodsHIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support.ResultsOf 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1–3.2) and Christian affiliation (OR 1.4, CI 1.0–2.0) and negatively associated with primigravidity (OR 0.5; 0.3–0.9) and new HIV diagnosis (OR 0.6, CI 0.4–0.9).ConclusionsPrimary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored.Trial RegistrationClinicalTrials.gov number NCT01936753, registered September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1417-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Sam-Agudu

Isah

Fan-Osuala

et al. 2017

BMC Pregnancy Childbirth

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“…Furthermore, Nigeria has a large PMTCT burden, along with wide program gaps: only 30% of approximately 200 000 HIV-positive and pregnant Nigerian women receive antiretroviral drugs annually, and only 9% of HIV-exposed infants receive timely early infant diagnosis testing [ 22 , 23 ]. In Nigeria, structured MM peer support has been shown to improve maternal retention and viral suppression [ 24 ] as well as timely infant presentation for HIV testing [ 25 ]. Similar findings on the positive impact of peer support on PMTCT outcomes have been reported from other African countries [ 1 , 26 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Sam-Agudu

Odiachi²,

Bathnna

et al. 2018

Hum Resour Health

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BackgroundIn HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs’ impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers.MethodsThis study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach.ResultsBoth intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions.ConclusionsMMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration.Trial registrationClinicaltrials.gov number NCT01936753, registered September 3, 2013.

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“…Our study showed no signi cant association between the MoMent study's structured mentor mother support intervention and infant survival. While there is ample evidence on the positive impact of maternal peer support on maternal PMTCT retention, adherence and viral suppression, EID timeliness/uptake, and rate of vertical transmission in Nigeria (20,21) and in sub-Saharan Africa and globally (56)(57)(58)(59)(60)(61)(62), few studies explicitly report on its direct impact on HEI mortality. This may be due largely to sample size constraints; studies conducted so far-including ours-may not have been powered enough to investigate this.…”

Section: Discussionmentioning

confidence: 99%

“…Data presented in this paper was collected as part of the MoMent (Mother Mentor) study, one of six WHOsupported studies under its INSPIRE (Integrating and Scaling Up PMTCT through Implementation Research) initiative (18). MoMent evaluated the impact of structured maternal peer support on presentation/uptake for early infant diagnosis (EID) and maternal retention in care among women living with HIV and their HEI (19)(20)(21).…”

Section: Methodsmentioning

confidence: 99%

“…Between 2014 and 2017, pregnant women living with HIV (WLHIV) aged ≥ 15 years were enrolled and followed-up along with their HEI, until 12 months post-delivery. Women in both study arms had access to antenatal HIV testing, continued/prompt initiation of ART, Option B PMTCT regimens, infant feeding counseling, EID, and infant referral for ART if diagnosed HIV-positive (19,20). Detailed descriptions of participant recruitment have been previously published (19)(20)(21)(22).…”

Section: Participant Recruitmentmentioning

confidence: 99%

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Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Ozigbu

Erekaha

Chinaeke

et al. 2020

Preprint

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Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

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The Impact of Structured Mentor Mother Programs on Presentation for Early Infant Diagnosis Testing in Rural North-Central Nigeria: A Prospective Paired Cohort Study

Abstract: Closely supervised, organized MM support significantly improved presentation for EID among HIV-exposed infants in a rural Nigerian setting. Structured PS can improve rates of timely EID presentation and potentially the uptake of EID testing in resource-limited settings.

Cited by 41 publications

References 17 publications

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

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