A cluster-randomized control trial in two provinces of Zambia
BACKGROUND
For HIV-positive mothers, postnatal care visits are critical to avoid transmitting the disease to their babies. These visits increase access to early infant diagnostics, which test infants for HIV, and establish links to care for HIV-positive children. However, in Zambia, data suggests that there is a need to improve the HIV testing rates for HIV-exposed infants from the ages of 6 weeks to 18 months.
Clinics targeted at mothers and their infants have been proposed in various settings as a way to retain HIV-exposed infants in care until they complete the final stage of HIV testing at 18 months, where evidence suggests the risk of transmission to the infant from the mother decreases. One such clinic, called Umoyo, or ‘Clinic of Life’, in the Chinyania language, was established at Mtendere Mission Hospital in Chirundu District, Lusaka Province in 2007, with support from Churches Health Association of Zambia (CHAZ). The clinic now operates in selected facilities in five districts in Zambia. The Zambian Ministry of Health was interested in rigorously evaluating the impact of the Umoyo clinic model on the retention of mothers and infants. A 12-month, cluster-randomized control trial was carried out to determine if facilities with the Umoyo program improved the number of HIV-exposed infants retained in care.
APPROACH
CHAI conducted a two-arm, cluster-randomized trial in Lusaka and eastern provinces of Zambia to assess the change in proportion of HIV-exposed infants retained in care 12 months before and after the Umoyo clinic was launched at 14 intervention sites, compared to the retention in 14 control sites with the standard of care.
The target populations for the study were infants born to HIV-positive mothers within a four-month period (November 2015 through February 2016 for the pre-implementation period or November 2016 through February 2017 for the post-implementation period). The infants had already had their 6-week early infant diagnostic test as well as their first follow-up visit. Surveys were administered to mothers to determine self-reported social support and stigma.
IMPACT
While the Umoyo program did not improve the proportion of children who were retained in care at 12 months, we did find statistically significant improvements in mother’s reported scores for social support and reductions in health worker stigma over time.
