Abstract
ObjectiveWe evaluate the effect of clinic-based support by HIV-positive Peer Mentors, in addition to standard clinic care, on maternal and infant well-being among Women Living with HIV (WLH) from pregnancy through the infant's first year of life.MethodsIn a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for pregnant WLH to receive either: a Standard Care condition (SC; 4 clinics; n = 656 WLH); or an Enhanced Intervention (EI; 4 clinics; n = 544 WLH). WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors, in addition to SC. WLH were recruited during pregnancy, and at least two post-birth assessment interviews were completed by 57% of WLH at 1.5, 6 or 12 months. EI's effect was ascertained on 19 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 efficacy.FindingsWLH attended an average of 4.1 sessions (SD = 2.0); 13% did not attend any sessions. Significant overall benefits were found in EI compared to SC using the binomial test. Secondarily, over time, WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition. EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months.ConclusionsWLH benefit by support from HIV-positive Peer Mentors, even though EI participation was partial, with incomplete follow-up rates from 6–12 months.Trial RegistrationClinicalTrials.gov NCT00972699
Highlights
WLH benefit by support from HIV-positive Peer Mentors, even though Enhanced Intervention (EI) participation was partial, with incomplete follow-up rates from 6–12 months
Peer support is an important strategy for improving health outcomes for HIV, as it is for infant malnutrition, and adult diabetes [1,2,3]
With the number of healthcare personnel available in low- and middle-income countries (LMIC) unlikely to be sufficient to address HIV until the year 2050 [5], task-shifting to paraprofessionals is critical for supporting Women Living with HIV (WLH) to cope with their HIV-related stressors
Summary
Peer support is an important strategy for improving health outcomes for HIV, as it is for infant malnutrition, and adult diabetes [1,2,3]. Peer support improves health outcomes, but has the advantage of allowing tasks to be shifted from healthcare professionals to paraprofessionals [4]. With the number of healthcare personnel available in low- and middle-income countries (LMIC) unlikely to be sufficient to address HIV until the year 2050 [5], task-shifting to paraprofessionals is critical for supporting Women Living with HIV (WLH) to cope with their HIV-related stressors. We are currently analyzing the M2M program’s benefits of clinic-based HIV+ Peer Mentor support on post-birth outcomes of WLH and their infants [unpublished data]. This current paper extends that work and examines potential benefits of Peer Mentors over the first year of life
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