Community-facility linkage models and maternal and infant health outcomes in Malawi ’s PMTCT/ART program: A cohort study

by Michael E. Herce, Maganizo B. Chagomerana, Lauren C. Zalla, Nicole B. Carbone, Benjamin H. Chi, Michael T. Eliya, Sam Phiri, Stephanie M. Topp, Maria H. Kim, Emily B. Wroe, Chileshe Chilangwa, Jacqueline Chinkonde, Innocent A. Mofolo, Mina C. Hosseinipour, Jessie K. Edwards BackgroundIn sub-Saharan Africa, 3 community-facility linkage (CFL) models —Expert Clients, Community Health Workers (CHWs), and Mentor Mothers—have been widely implemented to support pregnant and breastfeeding women (PBFW) living with HIV and their infants to access and sustain care for prevention of mother-to-child transmission of HIV (PMTCT), yet their comparative i mpact under real-world conditions is poorly understood. Methods and findingsWe sought to estimate the effects of CFL models on a primary outcome of maternal loss to follow-up (LTFU), and secondary outcomes of maternal longitudinal viral suppression and infant “poor outcome” (encompassing documented HIV-positive test result, LTFU, or death), in Malawi’s PMTCT/ART program. We sampled 30 of 42 high-volume health facilities (“sites”) in 5 Malawi districts for study inclusion. At each site, we reviewed medical records for all newly HIV-diagnosed PBF W entering the PMTCT program between July 1, 2016 and June 30, 2017, and, for pregnancies resulting in live births, their HIV-exposed infants, yielding 2,589 potentially eligible mother–infant pairs. Of these, 2,049 (79.1%) had an available HIV treatment record and formed the study ...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research