HIV Clinical Trial
Official title:
The Impact of Mentor Mother Programmes on PMTCT Service Uptake and Retention at Primary Healthcare Facilities in Nigeria
Nigeria has significant challenges in the delivery and coverage of PMTCT (Prevention of
mother-to-child transmission of HIV) services. Only 30% of pregnant women living with HIV are
provided anti-retroviral drugs for PMTCT. Less than 10% of HIV-exposed infants receive HIV
testing for early diagnosis by age 2 months. Furthermore, an unacceptably high number of
women with HIV who are enrolled in PMTCT programs do not complete them. In other words,
uptake and retention in PMTCT programs in Nigeria is not adequate. Ultimately,
mother-to-child transmission of HIV is high, resulting in a high number of new child HIV
infections.
Mentor Mothers (MMs) are women living with HIV who provide peer support to other HIV-positive
women. MM programs have been incorporated into PMTCT programs in several African countries
with some success, but with varying levels of MM training and program structure. The MoMent
(MOther MENTor) study investigates whether highly-structured MM programs will further improve
uptake and successful completion of PMTCT services (eg testing and appointments) in Nigeria.
The study also evaluates the impact of structured MM programs on other outcomes, including
facility deliveries, new infant HIV infections, infant survival and maternal viral
suppression. Rural areas are the focus of this study because of their particularly poor
performance in PMTCT coverage and outcomes.
Nigeria has had a national HIV/AIDS care and treatment program in place since 2003. Included
in this national program are prevention programs; the largest of which is the
prevention-of-mother-to-child transmission (PMTCT) program. Despite more than 10 yrs of
providing PMTCT, Nigeria still has significant problems with uptake of, and retention in
these services. Only 30% of HIV-positive pregnant women receive HIV drugs for both treatment
and prophylaxis, and Nigeria has an estimated 41,000 new child infections annually, the
highest of any country in the world.
Mentor Mothers (MM) are women living with HIV who are experienced users and navigators of HIV
services, particularly PMTCT. Public health interventions engaging MM to support other
HIV-positive women for linkage and retention in PMTCT and treatment services has been tested
in South Africa, and has been adopted and applied in several other African countries. Similar
MM programs have also been adopted and implemented in Nigeria since 2007; however, objective
evaluations of MM impact on PMTCT service uptake and retention have not been performed to
date.
While MM and similar peer support interventions have shown some success in other African
countries, their implementation between and within countries has not been standardized.
Incremental impact may be gained with more structured, objective-specific MM programming and
service delivery.
The MoMent (MOther MENTor) is an implementation research study that is evaluating the impact
of structured vs routine peer support on PMTCT outcomes in Nigeria, focusing on two
North-Central states, the Federal Capital Territory and Nasarawa. The intervention consists
of a simple but detailed standardized training curriculum for MMs coupled with daily MM
supervision by dedicated personnel as well as standardized, user-friendly tools for both MMs
and their supervisors to use for service delivery. These trained MM, along with trained MM
Supervisors, form the basis of the Mentor Mother Intervention package. The choice of rural
areas served by Primary Healthcare Centers is due to the fact that PMTCT coverage and uptake
is lowest in these areas; the study sites are located in hard-to-reach-areas where a
significant number of PMTCT-eligible clientele live.
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