Abstract
The ACCLAIM Study aimed to assess the effect of a package of community interventions on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in maternal and child health (MCH) and prevention of mother-to-child HIV transmission (PMTCT) services. The study occurred from 2013 to 2015 in Eswatini, Uganda, and Zimbabwe. The three interventions were: (1) a social learning and action component for community leaders, (2) community days, and (3) peer discussion groups. Household cross-sectional surveys on community members’ MCH and PMTCT knowledge, attitudes, and beliefs were analyzed pre- and post-intervention, using MCH, HIV stigma, and gender-equitable men (GEM) indicators. We used t-tests to measure the significance of mean pre- vs. post-intervention score changes stratified by gender within each intervention arm and generalized linear models to compare mean score changes of the cumulative intervention arms with the community leaders-only intervention. Response rates were over 85% for both surveys for men and women, with a total of 3337 pre-intervention and 3162 post-intervention responses. The combined package of three interventions demonstrated a significantly greater increase in MCH scores for both women (diff = 1.34, p ≤ 0.001) and men (diff = 2.03, p < 0.001). The arms that included interventions for both community leader engagement and community days (arms 2 and 3)led to a greater increase in mean GEM scores compared to the community leader engagement intervention alone (arm 1), for both women (diff = 1.32, p = 0.002) and men (diff = 1.37, p = 0.004). Our findings suggest that a package of community interventions may be most effective in increasing community MCH/HIV knowledge and improving gender-equitable norms.
Highlights
MethodsInnovative approaches are needed to eliminate mother-tochild HIV transmission (MTCT) in high-burden countries
These barriers include inequitable gender norms, HIV-related stigma, and inadequate mother and child health (MCH) knowledge [3,4,5,6]. Interventions to address these barriers have included community health promotion and education activities, and engagement strategies [4, 7]. Many of these approaches focus on increasing knowledge, with insufficient attention paid to attitudes and norms; which is necessary to enable sustainable behavior change at the community level [8]
Barriers to prevention of mother-to-child HIV transmission (PMTCT) services are often interlinked; in that interventions which target both community and individual levels, may be more effective than interventions focused on one level
Summary
MethodsInnovative approaches are needed to eliminate mother-tochild HIV transmission (MTCT) in high-burden (priority) countries. Significant barriers remain that are not specific to HIV and that interfere with uptake of HIV treatment among pregnant women These barriers include inequitable gender norms, HIV-related stigma, and inadequate mother and child health (MCH) knowledge [3,4,5,6]. Interventions to address these barriers have included community health promotion and education activities, and engagement strategies [4, 7]. Many of these approaches focus on increasing knowledge, with insufficient attention paid to attitudes and norms; which is necessary to enable sustainable behavior change at the community level [8]. We tested an innovative community intervention package which included a social learning and action component (community leader engagement), community days (with community dialogues around selected MCH and PMTCT topics), and peer discussion groups, on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in MCH/PMTCT services in Eswatini (formerly Swaziland), Uganda, and Zimbabwe from 2013 to 2015
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