Effectiveness of a Lay Counselor-Led Combination Intervention for Retention of Mothers and Infants in HIV Care: A Randomized Trial in Kenya.
J Acquir Immune Defic Syndr
; 80(1): 56-63, 2019 01 01.
Article
em En
| MEDLINE
| ID: mdl-30399035
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.
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Base de dados:
MEDLINE
Assunto principal:
Complicações Infecciosas na Gravidez
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Cuidado Pré-Natal
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Infecções por HIV
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Transmissão Vertical de Doenças Infecciosas
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Fármacos Anti-HIV
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Mães
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article