PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers June 19, 2012...
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Transcript of PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers June 19, 2012...
PMTCT Outcomes Enhanced by Psychosocial Support and Education
for Mothers
June 19, 2012
Johannesburg, South Africa
m2m Goals
• Reduction in early and late transmission of HIV
• Reduction in maternal mortality associated with HIV
• Improved RMNCH
• Empowerment of women
• Reduction in stigma associated with HIV
m2m Overview
• Operating for over 10 years• Trains and employs women living with HIV
from local communities to provide PMTCT peer education and support
• Serves pregnant women, new mothers & their male partners
• Employed more than 4,000 Mentor Mothers since m2m’s founding
• Employs 1519 staff, in 609 health facilities in 7 countries
Key findings from m2m 2010 and 2011 client cohorts
Gestational age at 1st visit by country: most women present late for care
Kenya Lesotho Malawi South Africa
Swaziland Uganda Zambia Overall0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
7% 8% 7% 5% 5% 6% 5% 6%
49%52% 56%
45% 49% 44% 48% 47%
44% 40% 37%
50% 46% 49% 48% 47%
3rd trimester2nd trimester1st trimester
n=3474 n=751 n=983 n=10435 n=1624 n=308 n=669 N=18244
Uptake of any ARV during pregnancy, by country, 2010 and 2011 Cohorts
Lesotho Zambia Kenya South Africa Swaziland0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
82%77% 75%
53%
65%
83%
77% 75%71%
67%
2010 Cohorts
2011 Cohorts
* UNICEF. (2011). Children and AIDS: Fifth stocktaking Report, 2010. Geneva: UNICEF, UNAIDS, WHO & UNFPA.
*53% Uptake in Low to Middle income
countries
2011: n=771 n=724 n=3568 n=11123 n=1765
2010: n= 1313 n=991 n= 2059 n=4217 n=898
m2m clients receiving more psychosocial support report higher uptake of ARV during pregnancy
m2m Kenya* m2m Lesotho**
2 m2m visits 3 m2m visits 4+ m2m visits Kenya National Comparison
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
76%
85%
94%
73%
2 m2m visits 3 m2m visits 4+ m2m visits Lesotho National Comparison0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
82%
89%
96%
64%
*X2 =399.09, p<.001 **X2 =71.33, p<.001
n-=781 n=499 n=871 n-=164 n=127 n=242
Coefficients and odds ratio from logistic regression of uptake of any antenatal ARV amongst m2m clients in 2011
B S.E. 95% C.I. for EXP(B)
Lower Odds ratios Upper
Disclosure Not yet disclosed* 1 Disclose to anyone 1.14** .04 2.89 3.14 3.40
Done CD4 testNo* 1Yes .66** .04 1.77 1.93 2.10Came as a CoupleNo* 1Yes .09 .10 0.90 1.10 1.33Knowledge of Male partner status
No* 1Yes .39** .05 1.34 1.47 1.62Gestational at 1st visit 1st Trimester* 1 2nd Trimester .38** .08 1.25 1.46 1.713rd Trimester 1.32** .08 3.19 3.75 4.40Number of m2m antenatal visits
1 m2m visit* 1 2+ m2m visits .27** .05 1.19 1.31 1.443+ m2m visits .83** .07 2.02 2.30 2.624 + m2m visits 1.39** .07 3.52 4.03 4.60*Reference categoryR Square=.17 (Cox & Snell), .25 (Nagelkerke)**P<.001
High Disclosure rates amongst clients receiving psychosocial support in 2010 and 2011 Cohorts
Lesotho Kenya South Africa Swaziland m2m overall 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
78%
69%
61%
41%
70%
81%
72% 70%
61%
73%
2010 Cohorts2011 Cohorts
2011: n=1579 n=1250 n=5763 n=17200 n=4225 n=32120
2010: n= 1133 n= 2366 n= 4069 n= 4947 n=2573 n=15088
*Uptake of PCR testing amongst m2m clients higher amongst those enrolled earlier in psychosocial
support…
m2m client type overall pattern… m2m Country differentials…
Kenya
Leso
tho
Swaziland
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
57%50%
32%
73% 70%
58%
seen only after deliveryseen during pregnancy and after delivery
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
37%52%
*Fishers exact test for differences within countries, p<.001
n=12842 n=7200
*Infant PCR test positivity is lower amongst m2m clients enrolled earlier in psychosocial
support…Country Program
Enrolled to m2m after delivery N (%)
Total Enrolled during pregnancy & post deliveryN (%)
Total
Kenya 124 (12) 1038 52 (4) 1306
Lesotho 20 (12) 164 7 (3) 247
Malawi 14 (23) 60 1 (7) 40
South Africa 163 (11) 1456 32 (3) 1031
Swaziland 57 (10) 574 12 (4) 278
Uganda 28 (9) 323 4 (3) 157
Zambia 27 (10) 261 9(9) 98
*m2m overall 433 (11%) 3876 117 (4%) 3157
*Fishers exact test for differences between clients enrolled during pregnancy vs. enrolled post delivery p<.001
Discussion• m2m evidence shows that retention in psychosocial care
improves outcomes• “Dose response” importance of psychosocial visits=health
facility dose• Disclosure key to uptake and adherence of services• Earlier enrolment and follow through in psychosocial
services improve outcomes• Challenges
• Late presentation of women for antenatal care• Implications for retention and initiation in care
• Retention is challenging given inter-health facility movements in health systems
m2m services:• integrated in facilities, promote referrals• generate demand for PMTCT services,
treatment, and care to keep mothers alive
• stigma reduction diminishes demand-side barriers to ARV uptake
Demand Creation and Retention
Retention Initiatives
• Let’s SOAR (Strengthening Outcomes by Analyzing Results): enables site staff to understand data/improve program
• Active Client Follow Up (ACFU): active client follow-up improves client retention in PMTCT cascade through phone calls, SMSes, and/or home visits
1) Daily site-level data collection
2) Quarterly data review and action planning
3) Improve client health!
HOW we ‘SOAR’
m2m Program Department
16
Thank you!