1. Eliminating Paediatric AIDS in Zimbabwe Project
Do mother support groups increase retention in PMTCT programmes? Preliminary results of an 'INSPIRE' randomised controlled trial in Zimbabwe
Dr Geoff Foster1,2, Dr Abigail Kangwende3, Dr Talent Maphosa1,
Dr Angela Mushavi1, Prof Simbarashe Rusakaniko4,
Tonderai Sengai2, Bridget Shumba2, Pemberai Zambezi2

2. Study Objective
To test whether mother support groups based at health facilities increase retention of HIV-exposed infants and their mothers in PMTCT programmes

3. Mother Support Groups
MSGS are established at some health facilities in some countries
Some MSGs employ mentor mothers and provide incentives for attending mothers
MSGs have not been adopted by Ministries of Health in national PMTCT programmes
Attending MSGs may increase retention in PMTCT programmes. But scientific evidence is lacking

4. Design of MSGs Formative research led to the MSG design:
Meetings every two weeks at rural clinics
Administered by trained volunteer coordinators
Involving nurses as resource persons
Promoting retention, PS support and education
Not providing incentives (transport, refreshments nutritional support, materials etc)
Designed a sustainable model that might be replicated at Zimbabwe’s 1,600+ health facilities

5. EPAZ Research Project Other formative research: Scale of and Rusape
reasons for non-retention in PMTCT
Intervention: Mother support groups, est. 2014
Sites: 30 rural health facilities in 2 districts randomised
to standard of care or intervention arms
Enrolment: 394 HIV+ mothers < 35 weeks gestation
attending antenatal care in 2014/15 in two arms
Follow-up: Mothers and infants till 12 months postnatal
Rusape
Mutare

6. 30 rural health facilities (clinics) Arm 2, Mother Support Groups
Arm 1, Standard of Care
15 clinics
Arm 2, Mother Support Groups
15 clinics
HIV+ pregnant women attending ANC
526
HIV+ pregnant women attending ANC
454
980
Not assessed 48
Assessed
478
Assessed
432
Not assessed 22
910
Not eligible
154
Eligible
324
Eligible
308
Not eligible
124
632
Not enrolled
136
Enrolled
188
Enrolled
206
Not enrolled
102
394
279
Mother or baby died 11
Deliveries *
104
Deliveries *
175
Mother or baby died 11
PN follow-up >6m* 92
* As at 31 Oct. 2015

7. Mother Support Groups MSGs meet every two weeks
HIV-positive mothers join groups soon after booking
MSGs meet every two weeks
Groups are led by volunteer coordinators
Health information is given by clinic nurses

8. MSG Member Characteristics (n=51)
Not enrolled
Age
(yrs)
Primary
Secondary
Pentecostal
Apostolic or
Zionist
sects
Mainline
traditional
churches

9. Anti-retroviral treatment Infant nutrition & health
MSG Topics
Mother-
to-child transmission
Male participation
Anti-retroviral treatment
Infant nutrition & health 8 1 7 2
SESSION 6 3
Family planning & STIs 5 4
Disclosure
Delivery & infant testing
Positive living
4-monthly cycle

10. Mothers graduate after 6 months postnatal

11. Retention activities
Retention in ANC/PNC is stressed at each meeting

12. Promoting attendance
Members receive a reminder before each MSG meeting Non-attenders are contacted after missing an MSG meeting
The coordinator informs the sister of non-attenders
This activates home visits by village health workers

13. Retention in HIV care definition
Retention in HIV programmes: defining the challenges and identifying solutions: meeting report. WHO, 2012
2. Consolidated Strategic Information Guidelines for HIV in the Health Sector. WHO, May 2015
“When a patient enrolled in HIV care routinely attends these services, as appropriate to the need”

14. Retention Definitions, EPAZ, 2013
Attended in month 11 or 12
Postnatal Month
“Retained-in-care” at 1-year

15. Retention Definitions, EPAZ, 2013
Did not attend in month 11 or 12
Postnatal Month
“Not retained-in-care” at 1-year

16. Retention Definitions, EPAZ, 2013
Attended at least once every 2 months
Postnatal Month
“Fully retained-in-care” at 1-year

17. Retention Definitions, EPAZ, 2013
Did not attend at least once every 2 months
Postnatal Month
“Partially retained in care” at 1-year

18. Retention Definitions, EPAZ, 2013
Did not attend at least once every 2 months
Postnatal Month
“Not retained-in-care” at 1-year
“Partially retained in postnatal care”

19. Postnatal MSG attendance rates of mothers
93 mothers reached 6 months postnatal
Full 6m. MSG Attendance
(42%)
Partial 6m. MSG Attendance
(21%)
Partial MSG Attendance
(25%)
No MSG Attendance
(13%)
Attended M5/6, M1/2 and M3/4
(39)
Attended M5/6 but not M1/2 or M3/4
(19)
Did not attend M5/6, attended other MSGs
(23)
Never attended any MSG
(12)

20. Postnatal Attendance Rates of Mothers at MSGs by 2-month periods

21. MSG ATTENDANCE RATES BY CLINIC (n=143)
no. of enrolled mothers at each site 4 10 5 11 9 8 18 14 17
143 %
41%
34%

22. Reasons for MSG non-attendance (n=51)

23. Conclusions 1. MSG establishment is feasible; groups function well with limited external support 2. Retention-in-care and on-treatment definitions are needed to guide PMTCT service delivery 3. Early data on attendance of mothers in MSGs is encouraging. Results of whether MSGs increase retention in postnatal PMTCT care expected in If MSGs prove to be successful, expansion of MSGs at other sites may be implemented

24. centre of prevention of
Placing
children
at the
centre of prevention of
Where is the child in campaigns to vertical transmission. We need to make sure children are central in Prevention of Mother to Child Transmission Responses.

25. Thank you for remembering us

26. Postnatal mothers not attending an MSG

27. Mobile Phone Ownership
Health Facility
No. mothers enrolled in MSG
Members without phones
No (%)
Marange 20
Mayo 2 14 3 21
St Theresa 11 27
Chipfatsura 7 2 29
Nyazura 4
Chinyadza 8 38
Zvipiripiri 22 9 41
Rukweza 12 5 42
Matsika 43
Tandi 6 55
Burma Valley 58
Weya 16 10 63
Mayo 1 75
Total
188 67
36%

28. Average attendance at MSG meetings

29. No. enrolled mothers by health facility

30. Attendance at MSG meetings
Facility
no. mothers
never
1-3 meetings
4-7 meetings
 8 meetings
av. attendance
Matsika 8 2 4 64
Chipfatsura 5 1 3 60
Chitakatira 22 7 10
Nyazura 18 54
Mayo 2 16 51
Chinyadza 6
Mayo 1 49
Marange 23 11 44
Tandi 42
Burma Valley 14 38
Weya 12
Rukweza
St Theresa 19 36
Zvipiripiri 33
TOTAL
218
12 (5%)
62 (28%)
105 (48%)
39 (18%)
47%