The Impact of Structured Mentor Mother Programs on 6-Month Postpartum Retention and Viral Suppression among HIV-Positive Women in Rural Nigeria: A Prospective Paired Cohort Study

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

doi:10.1097/qai.0000000000001346

Cited by 53 publications

(63 citation statements)

References 18 publications

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“…7 This difference was present despite control sites also offering some individual peer support through local women living with HIV who were contracted, through the routine services, to provide similar help and counseling. The difference in effect appeared because of the quality of training and regular supervision provided to the expert mentor mothers and was not related to the ratio of women to local peer supporter or expert mentor mother.…”

Section: Peer Support Interventions and Retention In Care And Other Hmentioning

confidence: 99%

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

Rollins

Essajee

Bellare

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Identifying women living with HIV, initiating them on lifelong antiretroviral treatment (ART), and retaining them in care are among the important challenges facing this generation of health care managers and public health researchers. Implementation research attempts to solve a wide range of implementation problems by trying to understand and work within real-world conditions to find solutions that have a measureable impact on the outcomes of interest. Implementation research is distinct from clinical research in many ways yet demands similar standards of conceptual thinking and discipline to generate robust evidence that can be, to some extent, generalized to inform policy and service delivery. In 2011, the World Health Organization (WHO), with funding from Global Affairs Canada, began support to 6 implementation research projects in Malawi, Nigeria, and Zimbabwe. All focused on evaluating approaches for improving rates of retention in care among pregnant women and mothers living with HIV and ensuring their continuation of ART. This reflected the priority given by ministries of health, program implementers, and researchers in each country to the importance of women living with HIV returning to health facilities for routine care, adherence to ART, and improved health outcomes. Five of the studies were cluster randomized controlled trials, and 1 adopted a matched cohort design. Here, we summarize some of the main findings and key lessons learned. We also consider some of the broader implications, remaining knowledge gaps, and how implementation research is integral to, and essential for, global guideline development and to inform HIV/AIDS strategies.

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Section: Peer Support Interventions and Retention In Care And Other Hmentioning

confidence: 99%

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

Rollins

Essajee

Bellare

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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show abstract

“…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%

“…Twenty primary healthcare centers were selected and pair-matched based on facility pro le data. Ten intervention sites provided maternal peer support delivered in a structured program comprising closely-supervised, trained mentor mothers using standardized tools; 10 control sites delivered routine peer support from peer counselors with little to no training, tools or supervision (19,21).…”

Section: Study Design and Settingmentioning

confidence: 99%

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

et al. 2020

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Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

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The Impact of Structured Mentor Mother Programs on 6-Month Postpartum Retention and Viral Suppression among HIV-Positive Women in Rural Nigeria: A Prospective Paired Cohort Study

Abstract: Structured PS significantly improved postpartum PMTCT retention and viral suppression rates among women in rural Nigeria. Introduction of structure can enhance the impact of PS interventions on PMTCT outcomes.

Cited by 53 publications

References 18 publications

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

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

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

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