Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania.

Goodluck Willey Lyatuu,Roseline Urrio,David Sando,Shally Mwashemele,Deborah Kajoka,Nicola Orsini,Charles Kilewo,Emmanuel Philipo,Helga Naburi,Anna Mia Ekström,Brenda Simba,Peter Lyaruu,Ayoub Kibao,Gunnel Biberfeld,Nnodimele Onuigbo Atulomah

doi:10.1371/journal.pgph.0000256

Abstract

Peer support services are increasingly being integrated in programmes for the prevention of mother-to-child HIV transmission (PMTCT). We aimed to evaluate the effect of a peer-mother interactive programme on PMTCT outcomes among pregnant women on anti-retroviral treatment (ART) in routine healthcare in Dar es Salaam, Tanzania. Twenty-three health facilities were cluster-randomized to a peer-mother intervention and 24 to a control arm. We trained 92 ART experienced women with HIV to offer peer education, adherence and psychosocial support to women enrolling in PMTCT care at the intervention facilities. All pregnant women who enrolled in PMTCT care at the 47 facilities from 1st January 2018 to 31st December 2019 were identified and followed up to 31st July 2021. The primary outcome was time to ART attrition (no show >90 days since the scheduled appointment, excluding transfers) and any difference in one-year retention in PMTCT and ART care between intervention and control facilities. Secondary outcomes were maternal viral suppression (<400 viral copies/mL) and mother-to-child HIV transmission (MTCT) by ≥12 months post-partum. Analyses were done using Kaplan Meier and Cox regression (ART retention/attrition), generalized estimating equations (viral suppression) and random effects logistic regression (MTCT); reporting rates, proportions and 95% confidence intervals (CI). There were 1957 women in the peer-mother and 1384 in the control facilities who enrolled in routine PMTCT care during 2018-2019 and were followed for a median [interquartile range (IQR)] of 23 [10, 31] months. Women in both groups had similar median age of 30 [IQR 25, 35] years, but differed slightly with regard to proportions in the third pregnancy trimester (14% versus 19%); advanced HIV (22% versus 27%); and ART naïve (55% versus 47%). Peer-mother facilities had a significantly lower attrition rate per 1000 person months (95%CI) of 14 (13, 16) versus 18 (16, 19) and significantly higher one-year ART retention (95%CI) of 78% (76, 80) versus 74% (71, 76) in un-adjusted analyses, however in adjusted analyses the effect size was not statistically significant [adjusted hazard ratio of attrition (95%CI) = 0.85 (0.67, 1.08)]. Viral suppression (95%CI) was similar in both groups [92% (91, 93) versus 91% (90, 92)], but significantly higher among ART naïve women in peer-mother [91% (89, 92)] versus control [88% (86, 90)] facilities. MTCT (95%CI) was similar in both groups [2.2% (1.4, 3.4) versus 1.5% (0.7, 2.8)]. In conclusion, we learned that integration of peer-mother services in routine PMTCT care improved ART retention among all women and viral suppression among ART naïve women but had no significant influence on MTCT.

Highlights

Use of lifelong anti-retroviral treatment (ART) for all pregnant and breastfeeding women with HIV regardless of immunologic or clinical disease status, known as the WHO Option B + recommendation of 2012 [1], has been a major game changer in the efforts to end the HIV epidemic in children
Among women with data, slightly fewer (14.5%; 247 out of 1172) in peer-mother facilities compared to 18 9% (222 out of 1172) in control facilities were in third trimester of pregnancy
We found that integration of peer-mother support services resulted in significantly lower ART attrition rate (14 versus 18 per 1000 person months) over three and a half years of follow-up and a modest but significantly higher oneyear retention in Prevention of mother-to-child transmission of HIV (MTCT) (PMTCT) and ART care (78% versus 74%) in unadjusted analyses

Summary

Introduction

Use of lifelong anti-retroviral treatment (ART) for all pregnant and breastfeeding women with HIV regardless of immunologic or clinical disease status, known as the WHO Option B + recommendation of 2012 [1], has been a major game changer in the efforts to end the HIV epidemic in children. Retention (here defined as attendance within 90 days of appointment) as low as 76% at 12 months has been reported in a meta-analysis of 22 studies, conducted in the era of lifelong ART for all women in PMTCT care, across 8 African countries involving 60,890 women [4]. This meta-analysis highlighted low retention two to three years after enrolment in PMTCT care ranging from 41% to 74%, in studies that had two or more years of follow-up, a period that corresponds to the end of PMTCT follow-up [4]

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Discussion

Conclusion