“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Sam-Agudu, Nadia A.; Odiachi, Angela; Bathnna, Miriam; Ekwueme, Chinazom N.; Nwanne, Gift; Iwu, Emilia; Cornelius, Llewellyn J.

doi:10.1186/s12960-018-0313-9

Cited by 15 publications

(24 citation statements)

References 37 publications

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“…MMs project relatability and empathy to further motivate WLHIV to access and stay retained in care, which formal health workers are sometimes unable to do. We have previously documented the narratives of WLHIV (including MMs) regarding negative attitudes of health workers in Nigeria [35,36], and McLeish (2016) and Shrou (2013) described empathy from MMs that WLHIV felt health workers did not possess or demonstrate [26,28]. As with other African studies, our study respondents preferred MM support to last from pregnancy through several months post-partum [30], with lower-parity women receiving longer-term support than more experienced mothers.…”

Section: Discussionsupporting

confidence: 61%

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Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Odiachi¹,

Al-Mujtaba

Torbunde

et al. 2021

Preprint

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Background: Mentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria.Methods: We conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected.Results: Most participants were female (n=78, 67%), and married (n=110, 94%). All participant groups found MMs acceptable, as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers’ services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers.Conclusions: Mentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention. Trial registration: Clinicaltrials.gov registration number NCT 01936753, registered on September 3, 2013 (retrospectively registered).

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Section: Discussionsupporting

confidence: 61%

“…The recommendation for adequate MM compensation illustrates MM acceptability, and could promote program sustainability through improved lay worker satisfaction and performance [36,[39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 96%

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Odiachi¹,

Al-Mujtaba

Torbunde

et al. 2021

Preprint

Self Cite

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“…However, there are a number of challenges in the widespread adoption and scale up. These challenges include lack of formalized recognition within health care systems including lack of remuneration, standardized training, supervision, quality assurance and meaningful participation in decision-making [31, 46, 55–57]. Based on reports from several African settings, mentor mothers have first-hand knowledge of HIV, strong ties to communities, and can gain the trust of other mothers in their communities, making them particularly suited for community-based interventions [19].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study

Wanga

Helová

Abuogi

et al. 2019

BMC Pregnancy Childbirth

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Background Option B+ is a comprehensive antiretroviral treatment (ART) designed for HIV-infected pregnant/ postpartum women. However, barriers to implementing Option B+ and establishing long-term ART adherence while facilitating retention in prevention of mother to child transmission of HIV (PMTCT) services remain. Community-based mentor mothers (cMMs) who can provide home-based support for PMTCT services may address some of the barriers to successful adoption and retention in Option B+. Thus, we evaluated the acceptability of using cMMs as home-based support for PMTCT services. Methods Gender-matched in-depth interviews were conducted between September–November 2014 for HIV-infected pregnant/postpartum women and their male partners living in southwestern Kenya ( n = 40); additionally, we conducted four focus groups involving 30 health workers ( n = 70) within four health facilities. Audio-recordings were transcribed, translated, and then coded using a thematic analytical approach in which data were deductively and inductively coded with support from prior literature, identified themes within the interview guides, and emerging themes from the transcripts utilizing Dedoose software. Results Overall, the study results suggest high acceptability of cMMs among individual participants and health workers. Stigma reduction, improvement of utilization of health care services, as well as ART adherence were most frequently discussed potential benefits of cMMs. Participants pictured a cMM as someone acting as a role model and confidant, and who was over 30 years old. Many respondents raised concerns about breaches of confidentiality and inadvertent disclosure. Respondent suggestions to overcome these issues included the cMM working in different communities than where she lives and attending home-visits with no identifying clothing as an HIV-related health worker. Conclusions The home-based cMM approach may be a beneficial and acceptable strategy for promoting ART adherence and retention within PMTCT services for pregnant/postpartum women living with HIV. Considering the risks of inadvertent disclosure of HIV-infected status and related negative consequences for pregnant/postpartum women living with HIV, similar cMM program designs may benefit from recognizing and addressing these risks. Trial registration The MOTIVATE! study was registered on July 7, 2015 at the ClinicalTrials.gov ( NCT02491177 ). Electronic supplementary material The online version of this article (10.1186/s12884-019-2419-z) contains supplementary material, which is available to authorized users.

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“…These trial findings are largely supported by qualitative research, which confirm the overall feasibility and acceptability of the intervention [74‐76], including among adolescents [77]. For widespread implementation, however, adaptations may be required to fully optimize the role of peer supporters within the health system [78].…”

Section: Resultsmentioning

confidence: 79%

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

et al. 2020

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Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

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“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Cited by 15 publications

References 37 publications

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: A qualitative study

Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

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