Despite simplification of prevention of mother-to-transmission (PMTCT) services, retention of HIV positive (HIV+) mothers and infants across the PMTCT-pediatric care continuum remains problematic. A variety of interventions have been proposed to improve retention but rigorous assessment of their efficacy to improve maternal and child outcomes are scarce.
The Maternal-Infant Retention for Health (MIR4Health) study was conducted at 10 PMTCT sites in Nyanza, Kenya, between Sept 2013 –Sept 2015, to evaluate the effectiveness of a combination package of lay counselor administrated evidence-based interventions (Active Patient Follow-up/APFU) compared with the Standard of Care (SOC) on mother-infant retention. HIV+ pregnant women starting antenatal care were randomized to APFU (lay counselor administered individualized health education, home visits, phone and short message service appointment reminders, physical tracing immediately after missed clinic visits, and individualized retention and adherence support) vs. routine PMTCT/postnatal HIV care as per national guidelines. Retention of mother-infant pairs was defined as documented clinic attendance of mother and infant at 6 months (mos) postpartum ± 3 mos. Intent-to-treat analysis was used to assess the difference in retention between arms. Further analysis was done excluding women with pregnancy complications, neonatal/infant death, and transfer-out to compare lost-to-follow-up (LTFU).
340 HIV+ pregnant women were randomized to APFU (170) or SOC (170): 106 (31%) were known HIV+ (58 APFU, 48 SOC arms); median gestational age 24 weeks (IQR 17-28); median CD4+ 426 cells/mm3 (IQR 274-601). A total of 142 (83.5%) APFU women had a documented live birth vs. 130 (76.5%) SOC women (p=0.10). At 6 mos postpartum, 130 mother-infant pairs were retained in the APFU arm vs. 112 the SOC arm. APFU subjects were 16% more likely to be retained at 6 mos postpartum compared to SOC (RR=1.16, 95% CI: 1.01-1.33; p=0.03). After excluding pregnancy complications, transfers and neonatal/infant deaths, 10.3% of the APFU arm and 18.8% of the SOC arm were LTFU (RR=0.55, 95%CI: 0.30-0.99; p=0.04). There were 3 infants testing HIV DNA PCR positive in the APFU arm and 6 in the SOC arm (p=0.25).
Engaging lay workers to provide a combination package of evidence-based interventions improved retention and reduced loss to follow-up among mother-infant pairs in a high prevalence community in Nyanza, Kenya.