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

Abstract

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.

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

“…l educational (n = 5) [188][189][190]192,271 l social support (n = 5) 149,[201][202][203][204] l pharmacological agents or supplements (n = 1) 213 l midwifery-led interventions (n = 3) [221][222][223] l organisation of maternity care (n = 0) l CAM or other (n = 0).…”

“…psychological (n = 30) 61,121,148, 2. educational (n = 17) [180][181][182][183][184][185][186][187][188][189][190][191][192][193][194][195][196] 3. social support (n = 11) 149,[197][198][199][200][201][202][203][204][205][206] 4. pharmacological agents or supplements (n = 10) [207][208][209][210][211][212][213][214][215][216] 5. midwifery-led interventions (n = 9)…”

“…Of the five included trials 149,[201][202][203][204] evaluating social support interventions for the selective prevention of PND, only two were conducted in the UK. 149,201 Peer support was the main type of social support intervention identified: booklet on PND, 149,201,203 as well as support in labour 204 and a booklet plus video.…”

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…In addition to the peer element of the intervention that is vital, the individual nature of the intervention reflects the no one-size-fits-all finding of our study while providing a clear structure to enable the effects of the intervention to be evaluated. A number of studies in other HIV settings have found that patients benefit from peer support, [87][88][89] and the evidence in the UK so far has been promising but limited in scale. 90 DOI: 10.3310/hsdr05130 HEALTH SERVICES AND DELIVERY RESEARCH 2017 VOL.…”

Suporte social de gestantes com HIV: revisão narrativa

“…Participação em programas de prevenção 13,16,[18][19][20][23][24][25][26][27][28] Acolhimento da equipe de saúde 11,16,21,24 Educação em saúde 20 Conforto das condições de saúde 24 Divulgação do estado sorológico [16][17][18][19] Aderir às medidas de profilaxia da TV 11,[16][17][18][19] Repercussões na saúde sexual 13 Deus e a fé 15,24,27 Divulgação do estado sorológico 29 Motivação para aceitar o diagnóstico e o tratamento 24 repercussões na saúde sexual: consideraram-se com maior capacidade para negociar o planejamento familiar, além do uso de preservativo, e solicitar ao companheiro que realizasse o teste de anticorpos do HIV.…”