Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: A one-year implementation study

Abstract

BackgroundEffective Prevention of Mother to child Transmission of HIV (PMTCT) relies heavily on follow-up of HIV-infected women and infants from antenatal, through postnatal, to the end of the breastfeeding period. In Uganda, postnatal (PNC) follow-up remains below 50 % creating a missed opportunity for linkage to comprehensive HIV care and early infant diagnosis (EID). We evaluated the use of HIV infected peer mothers (peers), community lay persons and Village health team (VHT) members to improve PNC follow up and EID in urban and rural health units.MethodsStudy participants were HIV-infected women recruited from antenatal clinics at three urban clinics (Mulago, Rubaga and Mengo hospitals) and one rural health centre (Mpigi Health centre IV) between January and September 2010. The women were followed through delivery and the mother-infant pairs for the 6-week postnatal visit and up to 14 weeks for EID. Peers, community lay persons and VHT members were identified and trained in basic PMTCT and reproductive health (RH). They were then assigned to study clinic to support and follow study participants, their partners and infants through provision of health education, counseling, home visits, and phone call reminders. Six week PNC attendance was measured as a proportion of mother-infant pairs that returned for the 6-week postnatal follow up visit (5–8 weeks) while EID was measured as the proportion of HIV-exposed live birth that had an HIV test done by 14 weeks of age. Data at baseline (one year before the intervention) was compared with that during the one year study period among study participants and HIV infected women and their HIV-exposed infants in the whole clinic population.ResultsA total of 558 HIV-infected pregnant women were recruited for the study, 47 mother-infant pairs were censured before 6 weeks due to stillbirth (14), infant death < 6 weeks (23), death of participant (04) and loss to follow up before delivery (6). 401/511 (78.5 %) of mother-infant pairs returned to the study clinics at six-week, while 441/511 (86.3 %) infants were tested for HIV infection by 14 weeks of age. The baseline six-week PNC follow up was 37.7 % and increased during the study period to 78.5 % and 39.1 % among study participants and whole clinic population respectively, an incremental difference of 39.4 % (P < 0.001). EID increased from a baseline of 53.6 % to 86.3 % and 65.8 % among study and whole clinic population respectively during the study period, an incremental difference of 20.5 % (P < 0.001).ConclusionsUse of peers, community lay persons and VHT members led to a significant increase in six-week postnatal follow up of HIV infected women and EID among HIV exposed infants in the four study clinics. Our study supports the use of peers to improve early postnatal follow up and EID and should be implemented in other health units to support the PMTCT cascade.

Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as “family planning champions” increases referrals and uptake of family planning among HIV-infected mothers

“…This process ensured that women would get essential information and not get lost between and within PMTCT/PNC and FP clinics. These results support evidence from previous studies that in busy settings with low services utilization, peer mothers’ involvement contributes to increased PMTCT services uptake [25, 26]. …”

“…The utilization of peers can offer an affordable and feasible task shifting solution to address frequently missed FP opportunities among HIV infected women attending PMTCT/PNC clinics. Our findings are supported by evidence from a previous study conducted at our site, that demonstrated that employing HIV-infected peers compared to community lay persons was more effective in increasing the six-week postnatal follow up of HIV-infected mothers and the early HIV testing of their infants [25]. Earlier studies and programs carried out in Uganda and Malawi, also found that use of peer mothers/educators helped in improving knowledge and retention in long-term HIV care among women living with HIV [26, 32].…”

“…In our previous paper we demonstrated that use of peers, influential community lay persons and Village Health Team (VHT) members increased 6-week mother-baby postnatal attendance from 37.1% at baseline to 78.5% and increased early infant diagnosis from 53.6% to 86.3% among mothers and their infants. The increase was majorly attributed to the peer mothers’ support, because the mothers reported to be more comfortable sharing their problems with the peers than the community lay persons; most mothers only disclosed their HIV status to peers and the project staff and declined to be followed by the community lay persons [25] . In another study conducted in Western Uganda, employing peer mothers resulted in increased uptake of family planning services among women living with HIV by 79% ( p  < 0.001) [26] However, in areas where PMTCT is well managed with high services uptake, peer mothers have limited additional benefit in increasing uptake of core PMTCT services.…”

Male Partners Involvement in Prevention of Mother-to-Child Transmission of HIV Services in Southern Central Ethiopia: In Case of Lemo District, Hadiya Zone

“…HIV remains a major challenge globally regardless of decades of advocacy and investment in programs to control the spread of the virus [4, 5]. Globally, an estimated 35.3 million people were living with HIV in 2012 [6, 7]. The number of newly infected children in 2012 was 260,000 in low- and middle-income countries [7].…”

“…Male involvement is said to be very low in many health facilities in Ethiopia and it is one of the potential program gaps unfavourably affecting PMTCT services uptake in the country [18]. For this reason, previously in a country it was highlighted as involving male partners in ANC/PMTCT can often be utilized as an entry point for the provision of additional PMTCT services notably partner testing, condom use, and infant feeding recommendations for both male and female participants [6, 14]. …”