Abstract
BackgroundIn HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs’ impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers.MethodsThis study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach.ResultsBoth intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions.ConclusionsMMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration.Trial registrationClinicaltrials.gov number NCT01936753, registered September 3, 2013.
Highlights
In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT)
In the context of HIV service delivery, mentor mothers (MMs), known as expert mothers, are HIV-positive women with first-hand experience as exemplary clients in the prevention of mother-to-child transmission of HIV (PMTCT) who provide experiential guidance for other women living with HIV [1,2,3,4,5]
While we interviewed Healthcare worker (HCW) to assess acceptability of MMs as part of the formative aspect of Mother Mentor (MoMent) [35, 44], we did not interview HCWs for the latter Focus group discussion (FGD)—they were limited to MMs only
Summary
In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). In the context of HIV service delivery, mentor mothers (MMs), known as expert mothers, are HIV-positive women with first-hand experience as exemplary clients in the prevention of mother-to-child transmission of HIV (PMTCT) who provide experiential guidance for other women living with HIV [1,2,3,4,5]. Beyond their personal experience, MMs often receive training to enhance their peer support services and work alongside formal healthcare workers (HCWs) [1, 4, 5]. Task shifting is helpful in low-resource settings where there is a shortage of human resources for health with concomitant high burden of disease
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