A mobile health-facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial.

Nishi Suryavanshi,Nikhil Gupte,Abhay Kadam,Srilatha Sivalenka,Robert C Bollinger,Vidya Mave,Jane Mckenzie‐White,Savita Kanade,V Sampath Kumar,Anita Shankar,Asha Hegde,Amita Gupta

doi:10.1002/jia2.25555

Abstract

IntroductionIndia’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services.MethodsA cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models.ResultsOf 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC.ConclusionsThe COMBIND intervention was easily integrated into India’s existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.

Highlights

India’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother-to-child transmission (PMTCT) guidelines in 2013
COMmunity home Based INDia (COMBIND) was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio, 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks than SOC
A cluster was defined as one integrated counselling and testing centre (ICTC), all enrolled outreach workers (ORWs) affiliated with that ICTC, and enrolled HIV-positive pregnant/postpartum women assigned to their care

Summary

Introduction

India’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother-to-child transmission (PMTCT) guidelines in 2013. Results: Of 1191 HIV-positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Conclusions: The COMBIND intervention was integrated into India’s existing PMTCT programme and improved early uptake of two PMTCT components that require self-motivated health-seeking behaviour, providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. World Health Organization (WHO) HIV Prevention of Mother-to-Child Transmission (PMTCT) guidelines have been adopted by many high HIV burden countries [1], including India, yet uptake of these recommendations remains largely sub-optimal [2,3,4,5,6,7,8], Globally, India contributes the third largest HIV burden and ranks 10th in the annual burden of HIV-positive women and children. India’s national PMTCT programme prioritizes four components of the 2010 revised WHO PMTCT guidelines: (1) ART provision among all HIV-positive pregnant/breastfeeding women; (2) promotion of exclusive breastfeeding

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