Effect of a congregation-based intervention on uptake of HIV testing and linkage to care in pregnant women in Nigeria (Baby Shower): a cluster randomised trial

Abstract

Summary Background There is a dearth of effective community-based interventions to increase HIV testing and uptake of antiretroviral therapy (ART) among pregnant women in hard–to-reach resource-limited settings. We assessed whether a faith-based intervention, the Healthy Beginning Initiative (HBI), would increase uptake of HIV testing and ART among pregnant women as compared to health facility referral. Methods This trial was conducted in southeast Nigeria, between January 20, 2013, and August 31, 2014. Eligible churches had at least 20 annual infant baptisms. Forty churches (clusters), stratified by number of infant baptisms (<80 vs. >80) were randomized 1:1 to intervention (IG) or control (CG). Three thousand and two (3002) self-identified pregnant women aged 18 and older participated. Intervention included heath education and onsite laboratory testing implemented during baby shower in IG churches, while participants in CG churches were referred to health facilities. Primary outcome (confirmed HIV testing) and secondary outcome (receipt of ART during pregnancy) were assessed at the individual level. Findings Antenatal care attendance was similar in both groups (IG=79.4% [1309/1647] vs. CG=79.7% [1080/1355], P=0.8). The intervention was associated with higher HIV testing (CG=54.6% [740/1355] vs. IG =91.9% [1514/1647]; [AOR= 11.2; 95% CI: 8.77-14.25, P-value=<0.001]. Women in the IG were significantly more likely to be linked to care prior to delivery (P<0.01) and more likely to have received ART during pregnancy (P=0.042) compared to those in the CG. Interpretation Culturally-adapted, community-based programs such as HBI can be effective in increasing HIV screening and ART among pregnant women in resource-limited settings. Funding National Institute of Health and President's Emergency Plan for AIDS Relief

Linkage to Care, Early Infant Diagnosis, and Perinatal Transmission Among Infants Born to HIV-Infected Nigerian Mothers: Evidence From the Healthy Beginning Initiative

“…Previously published results showed that women in churches randomized to the intervention arm were more likely to be screened for HIV, linked to care, and on ARV therapy during pregnancy. 35 Of the 3002 women who participated in HBI, 2254 received HIV testing [IG = 1514 (92%), CG = 740 (55%)]. A total of 72 of the 2254 women tested (3.19%) were identified to be HIV infected and gave birth to 69 live infants (including 1 set of twins).…”

“…We present a brief synopsis of HBI here; however, details of the study protocol, sample size, and power analysis are published elsewhere. 29,34 Enrollment began in January 2013 and was completed by September 2013. Follow-up of enrolled participants was completed by August 2014.…”

A Framework for Health Communication Across the HIV Treatment Continuum

“…60,61 Successful approaches at the community level include utilization of existing socially accepted community-based infrastructure (eg, churches) 62 and the use of lay counselors 21,63–65 to build trust and acceptability, mitigate stigma, and serve as an acceptable entry point into the HIV continuum. Other community-level interventions, including availability of counseling resources in the community and the provision of community-based testing services with or without peer or lay counselors (including door-to-door, self-testing, mobile-testing, workplace-based, school-based, church-based, etc.)…”

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

“…Community leaders are important to the provision of health information and education, and may influence behavioural and social norms in culturally appropriate ways (Leban 2011;USAID 2015). Mobilising faith leaders, in particular, has been instrumental in addressing the HIV epidemic globally, including the promotion of access to prevention of mother to child transmission services during prenatal care (Chi and Stringer 2015;Ezeanolue et al 2015;Widmer et al 2011). Leban (2011) argues that their views on well-being and their stature enable them to influence the supply and demand sides of health services.…”