Community Health Workers and Prevention of Mother-to-Child HIV Transmission in Tanzania

University of California (UC), Berkeley

Status: Completed

Conditions: HIV Infections; Vertical Transmission of Infectious Disease

Treatments: Behavioral: Community Health Worker intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT03058484

552553838b402 (Registry Identifier)

TW7.18

Details and patient eligibility

About

The investigators implemented and evaluated a pilot program in Shinyanga Region, Tanzania to bring prevention of HIV services to communities using community health workers (CHWs). The intervention aimed to integrate community-based maternal and child health services with HIV prevention, treatment, and care-bridging the gap between women and facility, and enhancing the potential benefits of Option B+. Option B+ is the current World Health Organization recommendation for prevention of mother-to-child transmission, but its success in sub-Saharan Africa may be threatened by overburdened clinics and staff. Consequently, paraprofessionals like CHWs can be key partners in the delivery and/or enhancement of health services in the community.

The study focuses on whether this approach: increases retention in care; improves adherence to antiretrovirals (ARVs); or improves the number of women initiating antiretroviral therapy and the timing of initiation. Investigators hypothesize improvements along primary and secondary outcome indicators in the treatment group. This evaluation helps illuminate both the impact and feasibility of the intervention, and the role that CHWs may play in the elimination of mother-to-child transmission services.

Enrollment: 1,830 patients

Sex: Female

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Women who were identified in one of the medical registers used for sampling at the facility, were HIV-positive, and had a child born in either the baseline or endline cohort time windows (January and December 2014 or April and October 2015).

Exclusion criteria

• Did not have sufficient information to link them across registers

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,830 participants in 2 patient groups

Control

No Intervention group

Description:

Standard of care, i.e. regular clinic services are provided prior to the study.

Community Health Worker Intervention

Experimental group

Description:

This arm is a four-part behavioral intervention that includes: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool.

Treatment:

Behavioral: Community Health Worker intervention