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Mother Support Groups and Mentor Mothers
to Improve PMTCT Retention-in-Care:
Design and Implementation Challenges from
the MoMent and EPAZ Projects
Dr. Nadia Sam-Agudu, PI
MoMent (Mother Mentor) Study, Nigeria.
Prof. Vhumani Magezi, Co-Investigator
EPAZ (Eliminating Paediatric AIDS in Zimbabwe)
Zimbabwe.
www.aids2014.org
Outline
• Two implementation research studies examining
the impact of Mentor Mothers and mother
support groups on PMTCT retention in care
• Share outline of each study
• Share common challenges
• Discussion ….
www.aids2014.org
Country PMTCT Data
Nigeria
Zimbabwe
170 million
12.9 million
3.1%
15.0 %
200-230,000
70,000
PMTCT ARV coverage
(2012)
17%
56%
EID coverage
4%
44%
~60,000
~9,000
No national data
No official data
Population (2012)
HIV prevalence (2012)
Annual No. HIV+
pregnant women
Annual No. new child
HIV infections
PMTCT retention-inwww.aids2014.org
care
PMTCT Program Needs:
Community-based interventions
• Nigeria (large size and population; low coverage);
Zimbabwe (smaller population, high prevalence, poor
retention)
• Peer PLHIV well-positioned to support PMTCT program
• Mentor Mothers (MM) and Mother Support Group (MSG)
concept already established but not rigorously evaluated
• IR projects designed to evaluate impact of MM and MSG
interventions in the context of PMTCT
www.aids2014.org
MoMent Study Design
• Intervention Arm: engages Mentor Mothers:
trained, closely supervised by MM supervisors
(MMS) within structured MM program.
• Control Arm: engages standard-of-care peer
counsellors: not formally trained, not closely
supervised, not optimally structured program.
www.aids2014.org
MoMent - Intervention and outcomes
• Mentor Mother: PMTCT-experienced HIV+ woman,
ideally with HIV-negative child.
– Typically recruited from MSG
– Trained on basic PMTCT/MCH, counselling
– Provide 18 to 24 months of support
• MM Supervisor: Post-secondary educated staff with
basic PMTCT/MCH and programming training
– Supervises MM and polices retention among MM clients
• MoMent outcome measures: proportion receiving EID,
and mother-infant pair (MIP) retention at 6 and 12
months post-delivery
www.aids2014.org
MoMent - Design and
Implementation Challenges
• MMs: 'Human' resource intervention intended to change
(health) 'human' behavior (pregnant women and mothers)
• Standardization and consistency of intervention and
measures:
– Standardized but simple English and Hausa training
curriculum
– Structured but feasible schedule of MM-client interactions
– Outcomes-relevant data collection tools
– Capturing MM supervisor’s oversight, auditing and direction
of MM activities
www.aids2014.org
MoMent - Design and
Implementation Challenges
• Introducing lay – but empowered- personnel into an
hierarchical healthcare system
– Potential friction in HCW-MM and HCW-MMS relationship
– Promote respect for, and acceptability of MMs while validating
role and impact of HCWs
• Defining and measuring MM activities that impact on
PMTCT outcomes
– Frequency, quality, intensity of MM-client interactions
– Home visits, phone calls MM logbook
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EPAZ
(Eliminating Paediatric AIDS in Zimbabwe)
www.aids2014.org
Mother Support Groups
• HIV-positive mothers join groups
after booking and leave at 6
months postnatal
• MSGs meet at each clinic in
Intervention Arm every two
weeks
• Groups are led by the MSG
coordinator
• Health information is given at
each meeting by a nurse
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No
Curriculum Topic
Key information
1
Mother-to-child transmission (MTCT)
1.
2.
Likelihood & timing of MTCT.
Reducing the risk of MTCT.
2
Anti-retroviral treatment (ART)
3
Infant delivery, testing & treatment
1.
2.
3.
4.
1.
2.
3.
Why lifelong ART?
Adherence.
Monitoring.
Side effects.
Delivery in health facilities
Infant testing.
Infant treatment.
4
Disclosure
1.
2.
Pros and cons of disclosure.
Informing your partner of your HIV status
5
Positive living
1.
2.
3.
Healthy living
Psychosocial support
Prevention of transmission to partners
6
Family planning & sexually transmitted
infections (STIs)
1.
2.
3.
Why family planning is important
Family planning products.
Prevention and treatment of STIs.
7
Infant nutrition & health
1.
2.
3.
Breastfeeding
Artificial feeding
Growth monitoring & child health
8
Male participation
1.
2.
3.
4.
Male attendance.
Male testing.
When your partner is HIV-negative.
Male participation in MRGs.
Standard format of MSG meetings
1
Opening prayer
2
Welcome new members
3
Outline the aims of the group
4
Reinforce confidentiality
5
Explain retention activities
6
Celebrate members’ new babies
7
Acknowledge HIV results of babies.
8
Celebrate graduations;
remind members of graduation
policy
Introduce the information topic
9
10 Next meeting
11 Closing prayer
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Retention activities of MSGs
• Importance of retention
stressed at each group meeting
• Coordinator sends SMS
reminder before each group
meeting to each member
• Coordinator sends reminder to
non-attending members after
each missed meeting
• Coordinator informs sister-incharge after two consecutive
missed meetings by a member
and encourages home visiting
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Improving PMTCT data
monitoring
The EPAZ project supports the
government Health Information System as follows:
– Baseline assessments of data verification at sites
– Initial training of health workers (HWs) in data entry
– Accompanying district health executive members on data
verification and on-the-job training visits
– Incentives to HWs based on data quality of ART and ante/post-natal registers to improve data collection
www.aids2014.org
MSG Design & Implementation
Challenges
1. Distinction between research and NGO programme
2. Standardization and consistency of MSGs across sites
3. Unpack and quantify what MSGs actually do, and how
they influence mothers’ behaviour, and how this gets
incorporated into the database and analysis plan
a.
b.
MSG collects data but variable quality of data
Ability to identify and measure significant activities within MSG
that influence outcome measures
4. Tension between ‘strict, highly controlled and
monitored intervention’ vs. maintenance of practical low
cost clinic-based model that could be scaled up
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Common challenges:
MoMent and EPAZ
• Standardization and consistency of “human resource”
intervention
• Balance between highly controlled research vs. practical
implementation of “human resource” interventions
• Data collection - retention outcomes ‘effect of
intervention’ vs intervention ‘process’.
– Measuring activities that impact on PMTCT outcomes – where
do you focus?
• Success factor correlation: MMS and MSG Coordinator
skill and innovation vs. intervention effect
www.aids2014.org
Tatenda!
Mungode!
Thank You All!
www.aids2014.org