Background
Rationale
Methods/design
Objectives
Hypotheses
Study endpoints and outcomes
Main outcomes |
---|
Retention (primary outcome) |
Proportion of HIV exposed infants who present for HIV DNA-PCR testing for early infant diagnosis in the first 6–8 weeks of life. |
Secondary outcomes |
Demand for services |
Proportion of all women presenting for first antenatal care (ANC) visit at less than 20 weeks gestation. |
Proportion of all women who complete a minimum of four ANC visits. |
Proportion of all women who deliver in a health facility. |
Proportion of male partners tested for HIV, of all pregnant women living with HIV |
Service uptake |
Proportion of HIV exposed infants who receive nevirapine (NVP) prophylaxis at birth. |
Proportion of HIV positive pregnant women who receive ART or ARV prophylaxis. |
Design
Formative research
Study setting
Indicator | Swaziland | Uganda | Zimbabwe |
---|---|---|---|
Total population, 2012b
| 1,231,000 | 36,346,000 | 13,061,239 |
Total fertility rate (per woman, 2012)b
| 3.41 | 5.96 | 3.8 |
Life expectancy at birth m/f (years, 2012)b
| 55/55 | 56/58 | 56/60g
|
Infant mortality rate (per 1,000 live births)c
| 85 | 54 | 64 |
Probability of dying under five (per 1,000 live births, 2012)b
| 80 | 69 | 84 |
Maternal mortality ratio (per 100,000 live births, 2013)b
| 310 | 360 | 525 |
National adult (15–49 years) HIV prevalence, 2012 (%)b
| 26.5 [24.6-28.3]a
| 7.2 [6.4-8.4]a
| 14.7 [13.8-15.6]a
|
HIV prevalence among women 15–49 years (%) | 31.1c
| 8.3d
| 17.7 [16.6-18.8]a, h
|
HIV exposed infants tested within 2 months of birth, 2010e
| 54 [47–61]a
| 11 [9–13] | 14 [12–16]a
|
ANC coverage - at least four visits (%)b
| 76.6 (2010) | 47.6 (2011) | 64.8 (2011)g
|
Percent births delivered in health facilityc
| 74 | 57.4 | 65.1h
|
Gross national income per capita (PPP international $, 2009–2013)f
| 3,080 | 510 | 820 |
GINI indexf
| 51.5 (2010) | 44.3 (2009) | na |
Population living on less than $2 per day (%)f
| 29.3 (2010) | 27.4 (2009) | na |
The interventions
Community leader engagement | Community days | Peer groups | |
---|---|---|---|
Men | Women | ||
• Training and capacity building on MCH/PMTCT, gender norms and HIV risk, HIV stigma and discrimination, planning and conducting activities, and community advocacy • Mobilization and dialogue on community solutions to the key health and behavioral gaps as identified from health facility and survey data • Support for the leaders to develop a community action plan (CAP) to organize community-wide social action for MCH/PMTCT. | • Community sensitization and event promotion activities •Large and small group presentations and facilitated discussions • Provision of general health and HIV related services. At minimum this will include: ◦ HIV counseling and testing ◦ HIV prevention information and counseling ◦ Blood pressure screening ◦ Glucose screening ◦Growth monitoring for children (MUAC) ◦Family planning information ◦TB screening ◦Referrals to appropriate health services | • Role of men in family health, including male sexual health • Surgical male circumcision as an HIV prevention mechanism • Chronic and lifestyle conditions • Gender-based violence • STIs, HIV/AIDS, safer sex • Family planning • Disclosure and awareness of HIV status • HIV discordancy among couples • PMTCT • The importance of safe sex during pregnancy • Planning within the family for safe delivery in a health facility • Infant feeding, including the importance of exclusive breastfeeding for the first six months • Infant HIV testing and prophylaxis, and general child health even when the child is well. | • Screening and prophylaxis for syphilis, HIV, tuberculosis (TB), and malaria • Preventive measures during pregnancy (tetanus toxoid immunization, de-worming, folic acid, and malaria prevention) • The importance of HIV testing for women and their male partners, safer sexual practices, the increased vulnerability to HIV during pregnancy and lactation • What PMTCT interventions exist and the support available to women and partners with HIV • Discussing health issues with male partners • Nutrition during pregnancy and prevention of anemia • Danger signs during pregnancy and labor • Preparing for delivery at the facility: birth preparedness and planning for transport • What to expect during labor and delivery, including HIV testing and prophylaxis if necessary • Infant and young child feeding (IYCF): EBF for the first six months • Danger signs during the neonatal period • Infant health: immunization and clinic visits, HIV testing • Postpartum health: family planning and safer sex • Looking after your own health: HIV testing, nutrition, birth spacing, ARV prophylaxis or treatment as applicable |
Implemented in all 45 clusters | Implemented in 30 clusters | Implemented in 15 out of 30 clusters |
Community leader engagement
Community days
Peer group intervention
Intervention timeline
Sample size and power
Community leaders
Country | Annual expected pregnancies per cluster (2011) | Estimated HIV+ pregnant womena
| Women recruitment target (5 clusters) | Number of women peer facilitators | Men recruitment target | Number of men peer facilitators | Number of community leaders |
---|---|---|---|---|---|---|---|
Swaziland | 264 | 82 | 708 | 16 | 236 | 5 | 111 |
Uganda | 1,419 | 118 | 2,730 | 61 | 910 | 20 | 120 |
Zimbabwe | 265 | 47 | 725 | 16 | 242 | 5 | 90 |
Total | 1,948 | 247 | 4,163 | 93 | 1,388 | 30 | 321 |