title: Effect of a congregation-based intervention on uptake of HIV testing and linkage to care in pregnant women in Nigeria (Baby Shower): a cluster randomised trial.
abstract: BACKGROUND
  Few effective community-based interventions exist to increase HIV testing and uptake of antiretroviral therapy (ART) in pregnant women in hard-to-reach resource-limited settings. We assessed whether delivery of an intervention through churches, the Healthy Beginning Initiative, would increase uptake of HIV testing in pregnant women compared with standard health facility referral.
  
  
  METHODS
  In this cluster randomised trial, we enrolled self-identified pregnant women aged 18 years and older who attended churches in southeast Nigeria. We randomised churches (clusters) to intervention or control groups, stratified by mean annual number of infant baptisms (<80 vs ≥80). The Healthy Beginning Initiative intervention included health education and on-site laboratory testing implemented during baby showers in intervention group churches, whereas participants in control group churches were referred to health facilities as standard. Participants and investigators were aware of church allocation. The primary outcome was confirmed HIV testing. This trial is registered with ClinicalTrials.gov, identifier number NCT 01795261.
  
  
  RESULTS
  Between Jan 20, 2013, and Aug 31, 2014, we enrolled 3002 participants at 40 churches (20 per group). 1309 (79%) of 1647 women attended antenatal care in the intervention group compared with 1080 (80%) of 1355 in the control group. 1514 women (92%) in the intervention group had an HIV test compared with 740 (55%) controls (adjusted odds ratio 11·2, 95% CI 8·77-14·25; p<0·0001).
  
  
  CONCLUSIONS
  Culturally adapted, community-based programmes such as the Healthy Beginning Initiative can be effective in increasing HIV screening in pregnant women in resource-limited settings.
  
  
  BACKGROUND
  US National Institutes of Health and US President's Emergency Plan for AIDS Relief.
authors.affiliation: School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA. Electronic address: echezona.ezeanolue@unlv.edu.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Obiefune
authors.affiliation: Healthy Sunrise Foundation, Las Vegas, NV, USA.
authors.forename: Chinenye O
authors.initials: CO
authors.lastname: Ezeanolue
authors.affiliation: Department of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Ehiri
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Alice
authors.initials: A
authors.lastname: Osuji
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Amaka G
authors.initials: AG
authors.lastname: Ogidi
authors.affiliation: Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Hunt
authors.affiliation: Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
authors.forename: Dina
authors.initials: D
authors.lastname: Patel
authors.affiliation: School of Community Health Sciences, University of Nevada, Reno, NV, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pharr
authors.affiliation: New York University Langone Medical Center, and NYU College of Global Public Health, New York, NY, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
mesh_terms: D000369:Aged, 80 and over; D016000:Cluster Analysis; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D009549:Nigeria; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data