Abstract
BackgroundPublic health systems in resource-constrained settings have a critical role to play in the elimination of HIV transmission but are often financially constrained. This study is an evaluation of a mother-infant-pair model called “Umoyo,” which was designed to be low cost and scalable in a public health system. Facilities with the Umoyo model dedicate a clinic day to provide services to only HIV-exposed infants (HEIs) and their mothers. Such models are in operation with reported success in Zambia but have not been rigorously tested. This work establishes whether the Umoyo model would improve 12-month retention of HEIs.MethodsA cluster randomized trial including 28 facilities was conducted across two provinces of Zambia to investigate the impact on 12-month retention of HEIs in care. These facilities were offering Prevention of Mother-to-Child-Transmission (PMTCT) services and supported by the same implementing partner. Randomization was achieved by use of the covariate-constrained optimization technique. Secondary outcomes included the impact of Umoyo clinics on social support and perceived HIV stigma among mothers. For each of the outcomes, a difference-in-difference analysis was conducted at the facility level using the unweighted t test.ResultsFrom 13 control (12-month retention at endline: 45%) and 11 intervention facilities (12-month retention at endline: 33%), it was found that Umoyo clinics had no impact on 12-month retention of HEIs in the t test (− 11%; 99% CI − 40.1%, 17.2%). Regarding social support and stigma, the un-weighted t test showed no impact though sensitivity tests showed that Umoyo had an impact on increasing social support (0.31; 99% CI 0.08, 0.54) and reducing perceived stigma from health care workers (− 0.27; 99% CI − 0.46, − 0.08).ConclusionThe Umoyo approach of having a dedicated clinic day for HEIs and their mothers did not improve retention of HEIs though there are indications that it can increase social support among mothers and reduce stigma. Without further support to the underlying health system, based on the evidence generated through this evaluation, the Umoyo clinic day approach on its own is not considered an effective intervention to increase retention of HIV-exposed infants.Trial registrationPan African Clinical Trial Registry, ID: PACTR201702001970148. Prospectively registered on 13 January 2017.
Highlights
The goal of eliminating vertical human immunodeficiency virus (HIV) transmission is embedded within the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90– 90-90 targets which are to be achieved by 2020 [1]
Abundant evidence shows that people living with HIV/ AIDS are better able to cope with the negative health stressors of discrimination and stigma in the presence of social support as it has been associated with positive health outcomes for such as self-efficacy, adherence to antiretroviral therapy (ART), quality of life, physical health, and mental health [8,9,10,11,12,13]
This study was commissioned to answer the question: “What is the impact of Umoyo mother-infant pair (MIP) clinics on retention of HIV-exposed infants in Prevention of Mother-to-ChildTransmission (PMTCT) care at 12 months after birth?”. Study design This impact evaluation was a two-arm, difference-in-difference, cluster randomized controlled trial conducted in Lusaka and Eastern provinces of Zambia. It assessed the change in proportion of HEIs retained in care 12 months before and after the Umoyo MIP clinic was launched in 14 intervention sites compared to the change in retention in 14 control sites with the standard of care
Summary
The goal of eliminating vertical human immunodeficiency virus (HIV) transmission is embedded within the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90– 90-90 targets which are to be achieved by 2020 [1]. HIV stigma and discrimination are two important detractors to the elimination of mother-to-child transmission of HIV as they are strong barriers against accessing HIV prevention, testing, and treatment services [4,5,6,7]. The WHO has recognized that people living with HIV/AIDS have important psychosocial needs that need to be integrated into HIV care such as prevention and treatment of mental health disorders, assistance on coping with discrimination and stigma and financial forms of assistance [14]. Facilities with the Umoyo model dedicate a clinic day to provide services to only HIV-exposed infants (HEIs) and their mothers. Such models are in operation with reported success in Zambia but have not been rigorously tested. This work establishes whether the Umoyo model would improve 12-month retention of HEIs
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