Community‐based approaches for prevention of mother to child transmission in resource‐poor settings: a social ecological review

Abstract

IntroductionNumerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain.MethodsFirst, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries.ResultsOur review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women’s groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as “community mobilization” remain poorly defined.ConclusionsEvidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions.

Pediatric HIV/AIDS in sub-Saharan Africa: emerging issues and way forward

“…Educating the youths especially girls will mean greater awareness of health and their health needs, possible better jobs and guaranteed economic empowerment later in life. It is also important that pregnant women are constantly educated on the best practices to limit MTCT using the health facilities and other resources within the community such as peer counselors to support exclusive breastfeeding, support groups and community based organizations 55 . HIV infected children need to better understand their infection and manage their status using various coping strategies such as peer support groups, selective disclosure, religion and acceptance 56 .…”

Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala

“…We therefore use a social ecological model, drawn from the work of Heise (1998), to structure our findings, moving from factors related to individual experience to situational and sociocultural/political factors which influence women's lives. Social ecological models are based on the assumption that behaviour is a product of various levels of processes acting in concert to shape behaviour (Busza et al, 2012).…”

Challenges in Implementing Patient‐centred Information Systems in Tanzania: An Activity Theory Perspective

“…immunization activities, by disseminating messages through schools, religious organization and influential leaders (Cutts, 1991;Chadambuka et al, 2012). Another approach is to use both facility and community based approaches (Busza et al, 2012;Marcos et al, 2012). Busza et al (2012, p.3) define community based approaches to PMTCT The Electronic Journal of Information Systems in Developing Countries www.ejisdc.org (Prevention of Mother to Child Transmission of HIV) as "strategies and interventions to improve health behavior and outcome that are delivered outside the formal health settings".…”

“…Specifically, the paper contributes to HIS literature which has elaborated how designed tools are utilized in practice at the level of primary health care of developing countries' context. In this literature there are few studies which have elaborated defaulter tracing practices in maternal and child health settings (see for example DeRenzi et al, 2012;MacLeod et al, 2012); since most studies on defaulter tracing practices are in vertical programs such as tuberculosis, HIV/AIDS and PMTCT (see for example Jones et al, 2005;Fraser et al, 2007;Nglazi et al, 2010;Busza et al, 2012;Thomson et al, 2011;Kalembo and Zgambo, 2012;Marcos et al, 2012).…”