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

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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.

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Notes

  1. The guidelines of the National Department of Health have since shifted to consistent breastfeeding (2005).

  2. While we reassessed 69 % of EI WLH post-birth, we documented intervention attendance among the full baseline sample. Among EI WLH assessed at baseline, 64 % attended at least one antenatal intervention session (mean 2.7 sessions, SD 1.1), 41 % attended at least one postnatal meeting (mean 2.5, SD 1.2), and 73 % attended any sessions (mean 3.8, SD 2.0).

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Acknowledgments

This study was funded by the National Institute of Mental Health (1R01MH077553) and supported by NIH Grants P30MH58107, 5P30AI028697, and UL1TR000124. We are grateful to all the families who took part in the study, and to members of the study team, Lungie Mkhize, Nonhle Mtungwa, Lindo Ndlovu, and Lungie Ntombela. Linda Richter and Mark Tomlinson are supported by the National Research Foundation (South Africa). Trial Registration: ClinicalTrials.gov. NCT00972699; South African trial registration: DOH-27-0812-2348.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Human Sciences Research Council, Durban, KwaZulu-Natal, South Africa

    Linda Richter, Alastair Van Heerden, Alan Stein & Heidi Van Rooyen

  2. University of California at Los Angeles (UCLA), 10920 Wilshire Blvd., Suite. 350, Los Angeles, CA, 90024, USA

    Mary Jane Rotheram-Borus, Jessica M. Harwood, W. Scott Comulada & Zihling Tang

  3. Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa

    Linda Richter

  4. Department of Psychiatry, Oxford University, Oxford, UK

    Alan Stein

  5. Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa

    Mark Tomlinson

  6. Africa Centre for Health and Population Studies, Mtubatuba, South Africa

    Tamsen Rochat

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  1. Linda Richter
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Correspondence to Mary Jane Rotheram-Borus.

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Richter, L., Rotheram-Borus, M.J., Van Heerden, A. et al. Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial. AIDS Behav 18, 706–715 (2014). https://doi.org/10.1007/s10461-014-0694-2

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