Citation
Herce, Michael E.; Chagomerana, Maganizo B.; Zalla, Lauren C.; Carbone, Nicole B.; Chi, Benjamin H.; Eliya, Michael T.; Phiri, Sam; Topp, Stephanie M.; Kim, Maria H.; & Wroe, Emily B., et al. (2021). Community-Facility Linkage Models and Maternal and Infant Health Outcomes in Malawi’s Pmtct/Art Program: A Cohort Study. PLOS Medicine, 18(9), e1003780. PMCID: PMC8516224Abstract
BACKGROUND: In 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 impact under real-world conditions is poorly understood.METHODS AND FINDINGS: We 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 PBFW 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 cohort. A randomly selected subset of 817 (40.0%) cohort members underwent a field survey, consisting of a questionnaire and HIV biomarker assessment. Survey responses and biomarker results were used to impute CFL model exposure, maternal viral load, and early infant diagnosis (EID) outcomes for those missing these measures to enrich data in the larger cohort. We applied sampling weights in all statistical analyses to account for the differing proportions of facilities sampled by district. Of the 2,049 mother-infant pairs analyzed, 62.2% enrolled in PMTCT at a primary health center, at which time 43.7% of PBFW were
URL
http://dx.doi.org/10.1371/journal.pmed.1003780Reference Type
Journal ArticleYear Published
2021Journal Title
PLOS MedicineAuthor(s)
Herce, Michael E.Chagomerana, Maganizo B.
Zalla, Lauren C.
Carbone, Nicole B.
Chi, Benjamin H.
Eliya, Michael T.
Phiri, Sam
Topp, Stephanie M.
Kim, Maria H.
Wroe, Emily B.
Chilangwa, Chileshe
Chinkonde, Jacqueline
Mofolo, Innocent A.
Hosseinipour, Mina C.
Edwards, Jessie K.