Effectiveness of a Lay Counselor-Led Combination Intervention for Retention of Mothers and Infants in HIV Care: A Randomized Trial in Kenya

Ruby N Fayorsey, Chunhui Wang, Duncan Chege, William Reidy, Masila Syengo, Samuel O Owino, Emily Koech, Martin Sirengo, Mark P Hawken, Elaine J Abrams, Ruby N Fayorsey, Chunhui Wang, Duncan Chege, William Reidy, Masila Syengo, Samuel O Owino, Emily Koech, Martin Sirengo, Mark P Hawken, Elaine J Abrams

Abstract

Background: Retention of mothers and infants across the prevention of mother-to-child HIV transmission (PMTCT) continuum remains challenging. We assessed the effectiveness of a lay worker administered combination intervention compared with the standard of care (SOC) on mother-infant attrition.

Methods: HIV-positive pregnant women starting antenatal care at 10 facilities in western Kenya were randomized using simple randomization to receive individualized health education, retention/adherence support, appointment reminders, and missed visit tracking vs. routine care per guidelines. The primary endpoint was attrition of mother-infant pairs at 6 months postpartum. Attrition was defined as the proportion of mother-infant pairs not retained in the clinic at 6 months postpartum because of mother or infant death or lost to follow-up. Intent-to-treat analysis was used to assess the difference in attrition. This trial is registered with ClinicalTrials.gov; NCT01962220.

Results: From September 2013 to June 2014, 361 HIV-positive pregnant women were screened, and 340 were randomized to the intervention (n = 170) or SOC (n = 170). Median age at enrollment was 26 years (interquartile range 22-30); median gestational age was 24 weeks (interquartile range 17-28). Overall attrition of mother-infant pairs was 23.5% at 6 months postpartum. Attrition was significantly lower in the intervention arm compared with SOC (18.8% vs. 28.2%, relative risk (RR) = 0.67, 95% confidence interval: 0.45 to 0.99, P = 0.04). Overall, the proportion of mothers who were retained and virally suppressed (<1000 copies/mL) at 6 months postpartum was 54.4%, with no difference between study arms.

Conclusions: Provision of a combination intervention by lay counselors can decrease attrition along the PMTCT cascade in low-resource settings.

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Study profile. **Eighteen verified transfers; 8 in the intervention arm and 10 in the SOC arm. These mother–infant pairs were included as retained in the subsequent calculations of mother–infant attrition. Total mother–infant pairs at 6 months including verified transfers: 260; combination intervention 138 and SOC 122.

References

    1. UNAIDS. Ending AIDS. Progress Towards the 90-90-90 Targets. Geneva, Switzerland: UNAIDS; 2017.
    1. Chi BH, Adler MR, Bolu O, et al. Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief. J Acquir Immune Defic Syndr. 2012;60(suppl 3):S78–S87.
    1. McNairy ML, Teasdale CA, El-Sadr WM, et al. Mother and child both matter: reconceptualizing the prevention of mother-to-child transmission care continuum. Curr Opin HIV AIDS. 2015;10:403–410.
    1. Keane J, Pharr JR, Buttner MP, et al. Interventions to reduce loss to follow-up during all stages of the HIV care continuum in sub-Saharan Africa: a systematic review. AIDS Behav. 2017;21:1745–1754.
    1. Okeke NL, Ostermann J, Thielman NM. Enhancing linkage and retention in HIV care: a review of interventions for highly resourced and resource-poor settings. Curr HIV/AIDS Rep. 2014;11:376–392.
    1. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18588.
    1. Colvin CJ, Konopka S, Chalker JC, et al. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One. 2014;9:e108150.
    1. Clouse K, Pettifor A, Shearer K, et al. Loss to follow-up before and after delivery among women testing HIV-positive during pregnancy in Johannesburg, South Africa. Trop Med Int Health. 2013;18:451–460.
    1. Fowler MG, Lampe MA, Jamieson DJ, et al. Reducing the risk of mother-to-child human immunodeficiency virus transmission: past successes, current progress and challenges, and future directions. Am J Obstet Gynecol. 2007;197(3 suppl):S3–S9.
    1. Duff P, Kipp W, Wild TC, et al. Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda. J Int AIDS Soc. 2010;13:37.
    1. Ambia J, Mandala J. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention. J Int AIDS Soc. 2016;19:20309.
    1. Geldsetzer P, Yapa HM, Vaikath M, et al. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care. J Int AIDS Soc. 2016;19:20679.
    1. Schwartz SR, Clouse K, Yende N, et al. Acceptability and feasibility of a mobile phone-based case management intervention to retain mothers and infants from an option B+ program in postpartum HIV care. Matern Child Health J. 2015;19:2029–2037.
    1. Shroufi A, Mafara E, Saint-Sauveur JF, et al. Mother to mother (M2M) peer support for women in prevention of mother to child transmission (PMTCT) programmes: a qualitative study. PLoS One. 2013;8:e64717.
    1. Marcos Y, Phelps B, Bachman G. Community strategies that improve care and retention along the prevention of mother-to-child transmission of HIV cascade: a review. J Int AIDS Soc. 2012;15:17394.
    1. Turan JM, Onono M, Steinfeld RL, et al. Implementation and operational research: effects of antenatal care and HIV treatment integration on elements of the PMTCT cascade: results from the SHAIP cluster-randomized controlled trial in Kenya. J Acquir Immune Defic Syndr. 2015;69:e172–81.
    1. van Lettow M, Bedell R, Mayuni I, et al. Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (option B+) 2014. J Int AIDS Soc. 2014;17:18994.
    1. Nance N, Pendo P, Masanja J, et al. Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: a cluster-randomized trial. PLoS One. 2017;12:e0181919.
    1. Rollins NC, Essajee SM, Bellare N, et al. Improving retention in care among pregnant women and mothers living with HIV: lessons from INSPIRE and implications for future WHO guidance and monitoring. J Acquir Immune Defic Syndr. 2017;75:S111–S114.
    1. Fayorsey RN, Chege D, Wang C, et al. Mother infant retention for health (MIR4Health): study design, Adaptations, and challenges with PMTCT implementation Science research. J Acquir Immune Defic Syndr. 2016;72:S137–S44.
    1. PEPFAR. PEPFAR 3.0 Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation; 2014. Available at: . Accessed January 19, 2018.
    1. WHO. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: WHO; 2016.
    1. Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Trop Med Int Health. 2010;15:1–24.
    1. Elul B, Saito S, Chung H, et al. Attrition from human immunodeficiency virus treatment programs in Africa: a longitudinal ecological analysis using data from 307 144 patients initiating antiretroviral therapy between 2005 and 2010. Clin Infect Dis. 2017;64:1309–1316.
    1. Myrtil MP, Puttkammer N, Gloyd S, et al. ART attrition across health facilities implementing option B+ in Haiti. J Int Assoc Provid AIDS Care. 2018;17:2325958218774037.
    1. Domercant JW, Puttkammer N, Young P, et al. Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti. Glob Health Action. 2017;10:1.
    1. Puttkammer N, Domerçant JW, Adler M, et al. ART attrition and risk factors among Option B+ patients in Haiti: a retrospective cohort study. PLoS One. 2017;12:e0173123.
    1. Lipira L, Kemp C, Domercant JW, et al. The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data. Int Health. 2018;10:54–62.
    1. Odeny TA, Bukusi EA, Cohen CR, et al. Texting improves testing: a randomized trial of two-way SMS to increase postpartum prevention of mother-to-child transmission retention and infant HIV testing. AIDS (London, England). 2014;28:2307–2312.
    1. Kebaya L, Nduati R, Wamalwa D, et al. Efficacy of mobile phone use on adherence to nevirapine prophylaxis and retention in care among HIV-exposed infants in PMTCT: a randomized control trial. Arch Dis Child. 2014;99(suppl 2):A329.
    1. Fincchario-Kesseler S, Gautney BJ, Khamadi S, et al. If you text them they will come; using the HIV tracking system to improve early infant diagnosis quality and retention in Kenya. AIDS. 2014;28:S313–S321.
    1. Aliyu MH, Blevins M, Audet CM, et al. Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial. Lancet HIV. 2016;3:e202–e11.
    1. Kiweewa FM, Wabwire D, Nakibuuka J, et al. Noninferiority of a task-shifting HIV care and treatment model using peer counselors and nurses among Ugandan women initiated on ART: evidence from a randomized trial. J Acquir Immune Defic Syndr. 2013;63:e125–e32.
    1. Mwapasa V, Joseph J, Tchereni T, et al. Impact of mother-infant pair clinics and short-text messaging service (SMS) reminders on retention of HIV-infected women and HIV-exposed infants in eMTCT care in Malawi: a cluster randomized trial. J Acquir Immune Defic Syndr. 2017;75(suppl 2):S123–S131.
    1. Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Control Council/Kenya, Kenya Medical Research Institute, National Council for Population and Development/Kenya, and ICF International. Kenya Demographic and Health Survey 2014. Rockville, MD: Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Control Council/Kenya, Kenya Medical Research Institute, National Council for Population and Development/Kenya, and ICF International; Available at: . Accessed January 19, 2018.
    1. Cherutich P, Kim AA, Kellogg TA, et al. Detectable HIV viral load in Kenya: data from a population-based survey. PLoS One. 2016;11:e0154318.
    1. UNAIDS. Count Down to Zero. Global Plan towards the Elimination of New HIV Infections Among Children and Keeping Their Mothers Alive. Geneva, Switzerland: UNAIDS; 2015.

Source: PubMed

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