- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02999334
HIV With Innovative Group Antenatal Care in Two African Countries
Study Overview
Detailed Description
More than 90% of women in sub-Saharan Africa use antenatal care (ANC) at least once in pregnancy. To leverage high attendance rates, most facilities bundle HIV prevention and prevention of maternal-to-child transmission (PMTCT) with ANC. Unfortunately, the quality of ANC in sub-Saharan Africa is sharply constrained by severe resource and staffing shortages, as reflected in numerous "missed opportunities" for PMTCT, clinical service delivery, and health education. Moreover, job satisfaction among the overburdened providers is low. To improve ANC quality, the investigators will adapt and pilot an innovative, evidence-based model of group ANC, an approach that restructures provider time, allowing health facilities to offer respectful, woman-centered and high quality ANC given the limitations.
In CenteringPregnancy (CP), the only evidence-based model of group ANC, 12 women meet jointly for two hour antenatal visits, assessing their own weights and blood pressures, meeting briefly with the provider for individual consultations, and engaging in facilitated health discussions. Randomized controlled trial (RCT) data from ethnically and socioeconomically diverse populations in the US demonstrated that CP is highly effective at improving ANC adherence, provider and client satisfaction, and maternal and child outcomes. In the US, the successful integration of HIV prevention into the CP model reduced sexually transmitted infections and increased condom use.
CP has not been implemented with fidelity and tested for efficacy in a low-resource country. With funding from the Chicago Developmental Center for AIDS Research, the investigators conducted preliminary work in Malawi and Tanzania which suggested that a CP-based model of group ANC was feasible and acceptable; both women and providers were excited and energized by the model. The purpose of this study is to build on this work and: 1) conduct the developmental work to collaboratively adapt CP materials for use in both countries (sessions, training guides, and implementation and evaluation strategies); 2) train providers and pretest activities; and 3) conduct a full-scale randomized pilot. Investigators will work directly with the Centering Healthcare Institute to implement this CP-based model of group ANC with fidelity. This study will result in a feasible, acceptable, and sustainable CP-based model of group ANC adapted for the constraints posed by poorly resourced health systems and those of the clients they serve. These pilot data will be used to generate retention rates and effect sizes for an RCT to test the efficacy of a CP-based group ANC model.
Group antenatal care is an innovative paradigm shift in ANC, and this rigorous evaluation of its impact will expand the limited scientific assessments of reconfigured ANC models and mother and infant health outcomes in low-resource countries in sub-Saharan Africa. Because this model was developed and tested in target countries with high HIV prevalence and poor maternal and neonatal outcomes, it has the potential for broad impacts on maternal and child health, including PMTCT, in other low resource settings.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Physically and mentally competent pregnant women over the age of 16 attending antenatal care
Exclusion Criteria:
- Less than 16 years of age
Study Plan
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
NO_INTERVENTION: Individual ANC (standard care)
Individual ANC is the standard of care.
Women arrive at the clinic and and are provided ANC services on a first come, first serve basis.
While waiting women who are present listen to a health lecture.
Women then complete laboratory tests, including HIV testing (at the first visit), then meet individually with a midwife for a brief one-on-one physical assessment.
Four ANC visits are recommended.
|
|
EXPERIMENTAL: Group ANC (intervention)
Women in CP-based group antenatal care (intervention) arrive at clinic at the scheduled appointment time and go directly to the group space.
The same group of 12 women and the midwife and co-facilitator are present at each session.
Women measure and record their own vital signs and weight.
Each then has a brief one-on-one assessment with the midwife in the group space room.
Instead of health lectures, the group engages in facilitated and interactive discussions using activities.
Four ANC visits are recommended.
|
To examine the effect of type of care on completion of the recommended antenatal and postnatal visits as well as perinatal health outcomes, including knowledge, behaviors, psychosocial well-being, pregnancy-related empowerment, satisfaction with ANC care.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adherence to Care
Time Frame: 6-8 weeks postpartum
|
Two Indicators: Attended 4 (or more) antenatal care visits (yes, no) and the 6-week postnatal visit (yes, no)
|
6-8 weeks postpartum
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Healthy Pregnancy Knowledge Index
Time Frame: Enrollment, 32-40 weeks gestation
|
14-item true/false questions measured two times in pregnancy and scored as percent correct (range 0-100%)
|
Enrollment, 32-40 weeks gestation
|
Healthy Pregnancy Behaviors
Time Frame: Enrollment, 32-40 weeks gestation
|
Substance use behaviors in the last two months for: tobacco products, alcohol, and marijuana.
Two nutritional behaviors were asked about.
One was whether or not she ate fruits or vegetables at least 3 times a day for 5 or more days in the past week.
The second focused on eating protein at least once a day for 5 or more days in the past week.
Measured two times in pregnancy.
Three or less of these five behaviors scored as 0 and four or more healthy behaviors were categorized as a 1 (Dichotomous)
|
Enrollment, 32-40 weeks gestation
|
Prevention of Mother-to-Child (PMTCT) Knowledge
Time Frame: Enrollment, 32-40 weeks gestation
|
4-item PMTCT knowledge index measured two times in pregnancy and scored as 1 if all four were correct and 0 if one or more item was incorrect (Dichotomous)
|
Enrollment, 32-40 weeks gestation
|
Comprehensive HIV Prevention Knowledge
Time Frame: Enrollment, 32-40 weeks gestation
|
5-item comprehensive HIV knowledge index measured twice in pregnancy.
Scored as 1 if all five items were correctly and 0 if one or more item was incorrect (Dichotomous)
|
Enrollment, 32-40 weeks gestation
|
Mental Distress
Time Frame: Enrollment, 32-40 weeks gestation
|
20-item yes/no Self Reporting Questionnaire (SRQ-20) to assess mental distress was measured two times in pregnancy.
Validated in multiple countries including Malawi and Tanzania (Range 0-20, baseline α = 0.789; late pregnancy α = 0.848).
We dichotomized scores to low (<8 symptoms) and high (≥8), a level used in clinics for referral.
(Dichotomous)
|
Enrollment, 32-40 weeks gestation
|
Pregnancy-Related Empowerment Scale (PRES)
Time Frame: 32-40 weeks gestation
|
The pregnancy-related empowerment scale (PRES) is a 16-item Likert-type scale with items ranging from 1 (strongly disagree) to 4 (strongly agree) that is intended to assess a woman's sense of control over their pregnancy health and health care.
Measured once in late pregnancy (Range 16-64, Continuous)
|
32-40 weeks gestation
|
Satisfaction with Care
Time Frame: 32-40 weeks gestation
|
10-item satisfaction with antenatal care index; Measured once in late pregnancy with 5 response options between 1 (poor) and to 5 (excellent) (Range 13-50, Continuous)
|
32-40 weeks gestation
|
Any Adverse Perinatal Event
Time Frame: 6-8 weeks postpartum
|
Fetal demise, stillbirth, neonatal death, preterm birth, low birth weight, or maternal death.
None experienced = 0; one or more = 1 (Dichotomous)
|
6-8 weeks postpartum
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Patil CL, Abrams ET, Klima C, Kaponda CP, Leshabari SC, Vonderheid SC, Kamanga M, Norr KF. CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals. Midwifery. 2013 Oct;29(10):1190-8. doi: 10.1016/j.midw.2013.05.008. Epub 2013 Jul 19.
- Liese KL, Kapito E, Chirwa E, Liu L, Mei X, Norr KF, Patil CL. Impact of group prenatal care on key prenatal services and educational topics in Malawi and Tanzania. Int J Gynaecol Obstet. 2021 Apr;153(1):154-159. doi: 10.1002/ijgo.13432. Epub 2020 Dec 2.
- Patil CL, Klima CS, Steffen AD, Leshabari SC, Pauls H, Norr KF. Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania. Int J Gynaecol Obstet. 2017 Dec;139(3):290-296. doi: 10.1002/ijgo.12324. Epub 2017 Oct 10.
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- NR14413-01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Prenatal Care
-
Oslo University HospitalUniversity of OsloCompleted
-
University of Campania "Luigi Vanvitelli"Completed
-
Meir Medical CenterCompleted
-
University of WashingtonUniversity of GondarCompletedPrenatal Care | Maternal Health Services | Perinatal CareEthiopia
-
Emory UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development... and other collaboratorsCompleted
-
HERA IncMedical Rescue Association (MEDAK), TurkeyNot yet recruitingPregnancy | Prenatal Care
-
Halic UniversityActive, not recruitingStress | Pregnancy Related | Noise Exposure | Prenatal Care Late | Prenatal StressTurkey
-
Hirabai Cowasji Jehangir Medical Research InstituteRecruitingFood Insecurity | Pregnancy Outcome | Prenatal CareIndia
-
Johns Hopkins Bloomberg School of Public HealthEunice Kennedy Shriver National Institute of Child Health and Human Development...CompletedHealth Literacy | Prenatal Care | NumeracyUnited States
-
Aydin Adnan Menderes UniversityCompletedNursing Caries | Newborn | Prenatal CareTurkey
Clinical Trials on Group Antenatal Care
-
Centers for Disease Control and PreventionJhpiego; Ministry of Health, TanzaniaTerminatedMalaria | Malaria in PregnancyTanzania
-
PossibleBrigham and Women's HospitalCompleted
-
JhpiegoBill and Melinda Gates Foundation; Addis Continental Institute of Public HealthTerminated
-
Karolinska InstitutetUppsala University; Dalarna University; La Trobe UniversityTerminated
-
Showa UniversityIndonesia UniversityUnknownPregnant Women | Preterm Delivery | Antenatal Care ModelIndonesia
-
University of Illinois at ChicagoNational Institute of Nursing Research (NINR); University of MalawiActive, not recruiting
-
Peking University Third HospitalPeking University; Peking University China Center for Health Development StudiesEnrolling by invitation
-
Cairo UniversityUnknown
-
IRCCS Azienda Ospedaliero-Universitaria di BolognaCompleted
-
Foundation for Professional Development (Pty) LtdNational Institute of Allergy and Infectious Diseases (NIAID); University of... and other collaboratorsRecruitingHIV/AIDS | Pregnancy | Cost-effectiveness | Antenatal Care | Chlamydia Trachomatis | Vaginal Microbiome | Birth Outcomes | Sexually Transmitted Infection | Neisseria Gonorrhoeae | Trichomonas VaginalisSouth Africa