Community leader engagement and peer group attendance improves selected MCH and PMTCT services uptake and retention: preliminary findings from project ACCLAIM
Background: Project Advancing Community Level Action for Improving maternal
and child health (MCH)/prevention of mother-to-child HIV transmission (PMTCT)
(Project ACCLAIM), a three-arm randomized trial with 45 PMTCT-implementing
health facilities and their catchment areas across Swaziland, Uganda and
Zimbabwe, aimed to improve access, uptake and retention in MCH and PMTCT
services.
The
study evaluates three interventions:
Arm 1) Community leader (CL) engagement (training
in MCH/PMTCT, community action mentoring including dialogues;
Arm 2) CL
plus community days (CDs), a community event with structured dialogues on
MCH/PMTCT and provision of health services;
Arm 3) CL plus CDs and male and
female MCH classes: four structured peer-led sessions. We report preliminary results
on outcomes of increased proportions of HIV exposed infants (HEI) receiving
HIV testing at 6-8 weeks, health facility deliveries, male partners tested.
Methods: Routine health facility data were collected prior to implementation
(July 2013, Swaziland and Zimbabwe, January 2014, Uganda) and for each quarter through
June 2015. We compared changes in proportions pre-implementation and the last
quarter after implementation in the three arms using chi square tests for
linear proportions.
Results: The interventions'' effects differed in the three
countries. In Uganda, the
proportion of HEI tested increased from 31% (56/182) to 48% (56/116), p< 0.001
in Arm 1, and in Arm 3 from 19% (20/106) to 43% (22/51), p< 0.001; male
partners tested increased from 11% (224/2,067) to 22% (533/2,475) p< 0.001 in
Arm 1 and 10% (71/728) to 15% (119/797) in Arm 3, p< 0.001. The proportion of
women delivering in health facilities increased from 60% (1,252/2,083) to 94%
(1,694/1,797) p< 0.001, Arm 1. In Swaziland the proportions of women
delivering in a health facility increased in both Arm 1 and Arm 3-49% (160/325)
to 81% (26 4/324) p< 0.001, and 50% (100/199) to 78% (153/195) respectively,
p< 0.001. In Zimbabwe, the proportions
of male partners tested increased in Arm 1 from 42% (66/159) to 73% (130/178),
p< 0.001.
Conclusions: The CL and peer group interventions appeared to
increase MCH/PMTCT services update and retention, with Uganda registering the
most improvements. The CL plus CD
intervention, Arm 2, appeared to have no effect on the outcomes.
G. Woelk1, M.P. Kieffer2, D. Mpofu3, R. Cathcart1, ACCLAIM Study Group
1Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, United States, 2Elizabeth Glaser Paediatric AIDS Foundation, Lilongwe, Malawi, 3Elizabeth Glaser Paediatric AIDS Foundation, Mbabane, Swaziland