The Tingathe programme: a pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi

Abstract

IntroductionLoss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants. We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant.MethodsPMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade.ResultsOver 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART.ConclusionsCase management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.

A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women

“…Similarly, in South Africa, partner involvement was identified as an enabler of ART adherence [32], [36], [46]. Findings for this factor in relation to retention were inconsistent in Malawi, however, where one study found lack of male involvement as a barrier to ART retention [23], and another found it as an enabler [34].…”

Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

“…We have shown in rural Mozambique that an enhanced referral process in which mothers were offered direct accompaniment to the site of EID testing for registration prior to discharge and given instructions in the mothers’ local native language improved EID uptake to 54.0% compared to 25.6% in the standard care group. 20 Other effective strategies can improve retention and uptake of HIV care along the PMTCT continuum, including: integrating EID services into routine infant care and immunization visits; 32,33 task-shifting to dedicated community health workers; 34 use of mobile technology for reporting EID results 35 and community strategies utilizing individuals or groups for advocacy, support, education, and tracking persons lost to follow-up. 36-40 Different clinics may have different problems in program implementation, such that quality improvement must be tailored for those deficits identified.…”

The Impact of Mentor Mother Programs on PMTCT Service Uptake and Retention-in-Care at Primary Health Care Facilities in Nigeria

“…Furthermore, previous studies conducted in other African countries compared peer counselors to "no peer intervention." 9,[13][14][15][16] In the MoMent (Mother Mentor) study, we evaluate the impact of a supervised, structured Mentor Mother program on PMTCT outcomes, as compared to routine informal peer support. We hypothesize that a structured Mentor Mother package will improve EID access, ARV adherence, and postdelivery MIP retention in rural communities.…”