Goodstart: a cluster randomised effectiveness trial of an integrated, community‐based package for maternal and newborn care, with prevention of mother‐to‐child transmission of <scp>HIV</scp> in a <scp>S</scp>outh <scp>A</scp>frican township

Tomlinson, Mark; Doherty, Tanya; Ijumba, Petrida; Jackson, Debra; Lawn, Joy E; Persson, Lars‐Åke; Lombard, Carl; Sanders, David; Daviaud, Emmanuelle; Nkonki, Lungiswa; Goga, Ameena; Rohde, Sarah; Sitrin, Deborah; Colvin, Mark; Chopra, Mickey

doi:10.1111/tmi.12257

Cited by 81 publications

(146 citation statements)

References 21 publications

(33 reference statements)

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“…These visits also increased infant weight and length-for-age z-scores, although no differences were found for MTCT or HIV-free survival (Tomlinson et al 2014). Similar increases in PMTCT service utilization were observed in Malawi's Tingathe PMTCT program, a CHW-based patient case management intervention (Kim et al 2012).…”

Section: Theory Of Changesupporting

confidence: 54%

“…It is well known that CHWs can enhance the reach, coverage and quality of HIV services delivered to the general population (Mwai et al 2013). However, specific evidence for leveraging this essential cadre to link community-based MNCH services with the PMTCT service cascade is small and primarily focused on infant outcomes (Kim et al 2012;le Roux et al 2013;Tomlinson et al 2014).…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Nance¹,

McCoy²,

Ngilangwa³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programs. We are the global leader in funding, producing and synthesizing high-quality evidence of what works, for whom, why and at what cost. We believe that high-quality and policy-relevant evidence will help make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania, as partial fulfilment of the requirements of grant TW7.18 issued under Thematic Window 7. The content has been copy-edited and formatted for publication by 3ie. Some of the content does not conform to the series report norms or standards, but has been accepted as is. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Sandra I McCoy, smccoy@berkeley.edu. AcknowledgementsThe authors would first and foremost like to extend our gratitude toward 3ie for funding this evaluation. We would like to thank the Ministry of Health and Social Welfare of Tanzania, and in particular the Shinyanga Regional Medical Officer Dr Ntuli Kapologwe; without their support, this project would not have been possible.We would also like to thank administrative and research staff at Amref Health Africa and University of California, Berkeley, whose collaboration on the project has been essential. We thank Karen Webb and Barbara Engelsmann at the Organisation for Public Health Interventions and Development in Zimbabwe. Lastly, but most importantly, we are thankful to the health facility staff and other local stakeholders who supported this project, and to the research assistants and the impact evaluation field coordinator who collected the data showcased here.ii Summary Community health workers are key frontline health paraprofessionals who have the potential to enhance the World Health Organization's Option B+ strategy to eliminate mother-to-child transmission of HIV. By extending the reach of health services into communities facing a shortage of skilled health workers, community health workers may enhance retention in prevention of mother-to-child transmission (PMTCT) services, including HIV care and adherence to antiretroviral therapy.To test this hypothesis, we evaluated the Mama na Mtoto Pamoja (Mother and Child Together) intervention that integrated community healt...

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Section: Theory Of Changesupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Nance¹,

McCoy²,

Ngilangwa³

et al. 2017

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“…[5] Furthermore, SA has one of the lowest exclusive breastfeeding rates in Africa (8% in infants under 6 months of age). [19] There is evidence from lowand middle-income countries, [8] including SA, [20] of the impact of CHWs undertaking breastfeeding promotion and counselling on improving exclusive breastfeeding.…”

Section: Corresponding Author: T Doherty (Tanyadoherty@mrcacza)mentioning

confidence: 99%

Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

et al. 2016

Self Cite

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“…That being said, in a recently published randomized control trial conducted in KwaZulu Natal (i.e. Goodstart Cohort (10) ), with community health workers employing motivational interviewing techniques in home visits postpartum, findings showed significant increases to EBF at 12 weeks postpartum. Future research applying our IMB model-based intervention as a packaged antenatal component to a postpartum programme (e.g.…”

Section: Implications and Future Workmentioning

confidence: 99%

“…The South Africa Department of Health reports only 8 % of all women are continuing to exclusively breast-feed at 6 months (8) . In the context of research studies conducted in South Africa, EBF rates among those in the intervention arms are reported as 10 % at 6 weeks in PROMISE-EBF (9) and 28 % at 28 weeks in the Goodstart Cohort (10) . HIV stigma, HIV disclosure between partners, cultural norms surrounding breast-feeding and previous infant feeding experiences are all reported challenges to adopting EBF (11)(12)(13)(14) .…”

Section: Introductionmentioning

confidence: 99%

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

Tuthill

Butler

Pellowski

et al. 2017

Public Health Nutr.

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Objective: Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women. Design: The Information-Motivation-Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial. Setting: Pietermaritzburg, South Africa, at two comparable rural public health service clinics. Subjects: Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum. Results: While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm. Conclusions: Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour. KeywordsExclusive breast-feeding HIV Infant feeding Information-MotivationBehavioural Skills South Africa Mother-to-child transmission of HIV Health benefits from breast-feeding positively impact mothers and provide unparalleled benefit for their infants, including reductions in morbidity (1)(2)(3) and improved survival (1) . Currently, the WHO and UNICEF recommend breast-feeding initiation within the first hours after birth; exclusive breast-feeding (EBF; i.e. feeding only breast milk and no other fluids or foods) for the first 6 months; and continued breast-feeding for up to 2 years or more (4) . EBF is also recommended for HIV-infected women living in resource-limited settings (5) . Among women on antiretroviral therapy (ART), current evidence shows that EBF with ART reduces the risk of HIV infection while increasing HIV-free infant survival compared with mixed-feeding (i.e. feeding breast milk and other foods or fluids) (6) . Specifically, during the postpartum period, ART coupled with EBF practice can reduce mother-to-child transmission of HIV from 25 % to less than 5 % (7) with some studies showing this decrease to less than 2 %. Given the benefits of breast-feeding and the n...

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Goodstart: a cluster randomised effectiveness trial of an integrated, community‐based package for maternal and newborn care, with prevention of mother‐to‐child transmission of HIV in a South African township

Cited by 81 publications

References 21 publications

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

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