A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants.
OBJECTIVE
We evaluate the effect of clinic-based support by HIV-positive Peer Mentors, in addition to standard clinic care, on maternal and infant well-being among Women Living with HIV (WLH) from pregnancy through the infant's first year of life.


METHODS
In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for pregnant WLH to receive either: a Standard Care condition (SC; 4 clinics; n = 656 WLH); or an Enhanced Intervention (EI; 4 clinics; n = 544 WLH). WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors, in addition to SC. WLH were recruited during pregnancy, and at least two post-birth assessment interviews were completed by 57% of WLH at 1.5, 6 or 12 months. EI's effect was ascertained on 19 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall efficacy.


RESULTS
WLH attended an average of 4.1 sessions (SD = 2.0); 13% did not attend any sessions. Significant overall benefits were found in EI compared to SC using the binomial test. Secondarily, over time, WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition. EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months.


CONCLUSIONS
WLH benefit by support from HIV-positive Peer Mentors, even though EI participation was partial, with incomplete follow-up rates from 6-12 months.


BACKGROUND
ClinicalTrials.gov NCT00972699.
Global Center for Children and Families, University of California, Los Angeles, California, United States of America.
Mary Jane
MJ
Rotheram-Borus
Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa ; HIV/AIDS, STIs and TB, Human Sciences Research Council, Durban, KwaZulu-Natal, South Africa.
Linda M
LM
Richter
Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Alastair
A
van Heerden
Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Heidi
H
van Rooyen
Department of Psychology, University of Stellenbosch, Matieland, South Africa.
Mark
M
Tomlinson
Global Center for Children and Families, University of California, Los Angeles, California, United States of America.
Jessica M
JM
Harwood
Global Center for Children and Families, University of California, Los Angeles, California, United States of America.
W Scott
WS
Comulada
Department of Psychiatry, Oxford University, Oxford, United Kingdom.
Alan
A
Stein
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000628:therapy* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008427:Maternal Health Services / Q000379:methods*; D008611:Mentors; D010379:Peer Group; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000523:psychology / Q000628:therapy*; D011295:Prenatal Care; D013019:South Africa; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D019380:Anti-HIV Agents