Enhanced peer-group strategies to support the prevention of mother-to-child HIV transmission

1. In a randomized control trial of women with HIV, both treatment groups had similar adherence to prevention of mother-to-child HIV transmission (PMTCT) clinic visits, or ART administration at 6 weeks, 12 months, and 24 months. 

2. At 2 years postpartum, women in the FLC intervention group had better adherence to PMTCT than women in the SOC intervention group. 

Evidence Rating Level: 1 (Excellent) 

Prevention of mother-to-child HIV transmission (PMTCT) is a huge part of the ongoing fight against HIV/AIDS. Option B+ recommends all women who are breastfeeding or pregnant to take triple ART regardless of their immune status, and newborns should take Nevirapine or Zidovudine for the first 4-6 weeks of life. This treatment has previously been recommended by the World Health Organization as the treatment option for PMTCT. However, there have been challenges adhering to option B+ especially in low-resource countries. To address these issues, a randomized control trial was conducted to see the comparison between PMTCT appointment adherence and ART at different time points postpartum. The participants were randomly assigned to either “Friends for Life Circles” (FLC) or to the MOH standard of care (SOC); two different peer support groups. Once again, the women were randomized in a 1:1 ratio to either the FLC experimental group or the SOC control group. Any infant born to a mother participating in the study was then enrolled and given daily Nevirapine from birth to 6 weeks of age. PMTCT appointment adherence at 6 weeks, 12 and 24 months postpartum, along with option B+ ART adherence at 6 weeks, 6 and 24 months postpartum, and continuation in care at the end of the study were the primary outcomes. A total of 540 eligible participants were randomly assigned to the intervention or control group until each group had 270 individuals. Both groups had a high care retention with 83.0% of participants remaining in care by the end of the follow-up period. However, more individuals were remaining in care in the FLC arm (86.7%) compared to the SOC arm (79.3%, p=0.0221). On the other hand, more women in the SOC arm (n=27, 10.0%) compared to the FLC arm (n=12, 4.4%) terminated care due to relocation. Compared to the FLC arm, more participants in the SOC arm dropped out from care (aHR=2.363, 95% CI: 1.199-4.656, p=0.013). Participants in rural communities along with participants between the ages of 15-24 were less likely to continue compared to their urban (p=0.015) and older counterparts (p=0.099) respectively. Overall, interventions providing group support and income-generation activities, such as the FLC intervention, may lead to people continuing with PMTCT care, higher rates of HIV-free children born to mothers with HIV, and the elimination of mother-child HIV transmission (EMTCT).

Click to read the study in PLOS

Image: PD

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