Conversations With Mothers: Exploring Reasons for Prevention of Mother-to-Child Transmission (PMTCT) Failures in the Era of Programmatic Scale-Up in Soweto, South Africa

Laher, Fatima; Cescon, Angela; Lazarus, Erica; Kaida, Angela; Makongoza, Matamela; Hogg, Robert S.; Soon, Christine N.; Miller, Cari L.; Gray, Glenda

doi:10.1007/s10461-010-9875-9

Cited by 46 publications

(45 citation statements)

References 23 publications

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“…Only about 74 % of eligible women were successfully tested for HIV and received their results across conditions, and only 62 % were recruited into the study [37]. Laher and colleagues found that WLH fear the stigma of being identified by others at the clinic as HIV seropositive and, therefore, may not test for HIV nor attend the intervention groups.…”

Section: Limitationsmentioning

confidence: 99%

Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial

et al. 2014

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Throughout Africa, Peer Mentors who are women living with HIV (WLH) are supporting pregnant WLH at antenatal and primary healthcare clinics (McColl in BMJ 344:e1590, 2012). We evaluate a program using this intervention strategy at 1.5 months post-birth. In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for their WLH to receive either: standard care (SC), based on national guidelines to prevent mother-to-child transmission (4 clinics; n = 656 WLH); or an enhanced intervention (EI; 4 clinics; n = 544 WLH). The EI consisted of four antenatal and four postnatal small group sessions led by Peer Mentors, in addition to SC. WLH were recruited during pregnancy and 70 % were reassessed at 1.5 months post-birth. EI's effect was ascertained on 16 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall effectiveness. Among EI WLH reassessed, 87 % attended at least one intervention session (mean 4.1, SD 2.0). Significant overall benefits were found in EI compared to SC using the binomial test. However, it is important to note that EI WLH were significantly less likely to adhere to ARV during pregnancy compared to SC. Secondarily, compared to SC, EI WLH were more likely to ask partners to test for HIV, better protected their infants from HIV transmission, and were less likely to have depressed mood and stunted infants. Adherence to clinic intervention groups was low, yet, there were benefits for maternal and infant health at 1.5 months post-birth.

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Section: Limitationsmentioning

confidence: 99%

Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial

et al. 2014

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“…68 Other contextual factors and challenges contributing to PMTCT failure needs to be taken into account in the planning and delivery of health interventions. The findings of a qualitatively exploration of such factors have highlighted a number of challenges.…”

Section: # #mentioning

confidence: 99%

“…68 Most Strategies to minimise risk of transmission during breastfeeding includes: 66 • EBF during the first 6 months…”

Section: # #mentioning

confidence: 99%

Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province

MNutrition

Statistician²

2015

South African Journal of Clinical Nutrition

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“…Guidelines for PMTCT have been implemented in most HIV-affected countries [4], however, PMTCT program failure and dropout occurs at all stages of the ante-, peri- and postnatal process [5]. Not all pregnant women are tested for HIV [6], not all women receive treatment [7] and not all mothers provided with medication take it themselves or give it to their newborns [8]. Safer infant feeding guidelines are not always followed, not all infants born to HIV-infected mothers are tested and treated [3] and mothers and newborns often miss postpartum clinic visits [9].…”

Section: Introductionmentioning

confidence: 99%

Implementing comprehensive prevention of mother-to-child transmission and HIV prevention for South African couples: study protocol for a randomized controlled trial

Jones

Peltzer

Sifunda

et al. 2014

Trials

106

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BackgroundIn rural South Africa, only two-thirds of HIV-positive pregnant women seeking antenatal care at community health centers took full advantage of ‘prevention of mother-to-child transmission’ (PMTCT) services in 2010. Studies generally support male involvement to promote PMTCT, but the nature and impact of that involvement is unclear and untested. Additionally, stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be ‘necessary, but not sufficient’ to reduce infant HIV incidence. This study expands on a successful United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported PMTCT couples intervention pilot study conducted in the Mpumalanga province, targeting HIV-positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention will significantly reduce infant HIV incidence.Methods/designThe study follows a cluster randomized controlled design enrolling two cohorts of HIV-positive pregnant women recruited from 12 randomly assigned Community Health Centers (CHC) (six experimental, six control). The two cohorts will consist of women attending without their male partners (n = 720) and women attending with their male partners (n = 720 couples), in order to determine whether the influence of male participation itself, or combined with a behavioral PMTCT intervention, can significantly reduce infant HIV infection ante-, peri- and postnatally.DiscussionIt is our intention to significantly increase PMTCT participation from current levels (69%) in the Mpumalanga province to between 90 and 95% through engaging women and couples in a controlled, six session ante- and postnatal risk-reducing and PMTCT promotion intervention addressing barriers to PMTCT (such as stigma, disclosure, intimate partner violence, communication, infant feeding practices and safer conception) that prevent women and men from utilizing treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV-positive pregnant women and their infants.Trial registrationClinicalTrials.gov NCT02085356 (registration date: 10 March 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-417) contains supplementary material, which is available to authorized users.

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Conversations With Mothers: Exploring Reasons for Prevention of Mother-to-Child Transmission (PMTCT) Failures in the Era of Programmatic Scale-Up in Soweto, South Africa

Cited by 46 publications

References 23 publications

Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial

Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial

Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province

Implementing comprehensive prevention of mother-to-child transmission and HIV prevention for South African couples: study protocol for a randomized controlled trial

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