Mother Infant Retention for Health: MIR4Health (MIR4HEALTH)
Linking HIV-infected pregnant women into prevention of mother to child transmission (PMTCT) services and keeping them in care is important in ensuring that both mother and infant beneﬁt from interventions that improve maternal health and decrease HIV transmission to infants. We propose an evaluation of strategies to link newly diagnosed HIV-infected women to care and keep them in care during pregnancy and after delivery in our study called MIR4HEALTH. The study will be conducted in Nyanza Province, Kenya. All participants will provide informed consent and will be randomized to receive the intervention, including individualized patient education, adherence support and phone call/Short Message Service (SMS) reminders for clinic appointments, or the standard of care (no additional intervention services).
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:||Mother Infant Retention for Health: Evaluation of a Multicomponent Strategy to Link and Retain Newly Identified HIV-infected Pregnant Women and Their Infants Throughout the Antenatal and Post-partum Period|
- Proportion of mothers and infants successfully retained in care at 6 months after delivery. [ Time Frame: 12 months ] [ Designated as safety issue: No ]Mother/infant 6-month Retention
- Proportion of women completing the 2nd ANC visit and all ANC and PN visits [ Time Frame: 6 months ] [ Designated as safety issue: No ]Completion ANC and PN visits
- Proportion of women who had a hospital delivery [ Time Frame: 6 months ] [ Designated as safety issue: No ]Hospital delivery
- Proportion of infants receiving PCR testing at 6 weeks of age and 6 months [ Time Frame: 6 months ] [ Designated as safety issue: No ]Infant PCR testing
- Proportion of male partners receiving HIV testing [ Time Frame: 12 months ] [ Designated as safety issue: No ]Male Partner HIV tests
- Proportion of infants exclusively breastfeeding at 6 months and number of months infant spent breastfeeding [ Time Frame: 6 months ] [ Designated as safety issue: No ]Exclusive Breastfeeding
- Change in CD4+ cell count from study enrollment to 6 month postpartum for women [ Time Frame: 12 months ] [ Designated as safety issue: No ]CD4+ Cell Count
- Proportion of women with undetectable HIV RNA at delivery and 6 months postpartum [ Time Frame: 12 months ] [ Designated as safety issue: No ]Undetectable Viral RNA
- Proportion of women adherent to ARV regimen during pregnancy and postpartum period [ Time Frame: 12 months ] [ Designated as safety issue: No ]Mother ARV Adherence
- Proportion of infants adherent to postnatal ARV regimen during first six weeks of life [ Time Frame: 1.5 months ] [ Designated as safety issue: No ]Infant ARV Adherence
- Proportion of women & staff reporting APFU highly acceptable [ Time Frame: 12 months ] [ Designated as safety issue: No ]Intervention Acceptability
|Study Start Date:||March 2013|
|Estimated Study Completion Date:||June 2015|
|Estimated Primary Completion Date:||June 2015 (Final data collection date for primary outcome measure)|
No Intervention: Standard of Care
Routine ANC, Delivery and Postpartum Care: All consenting women will receive routine ANC/Delivery and Postpartum care offered to pregnant women in Kenya as per national guidelines at the MCH of the respective facility.
Routine PMTCT and HIV Care: All newly diagnosed HIV-infected pregnant women are enrolled into HIV care in the MCH and receive PMTCT/HIV care per Kenya national guidelines (Revised 2012 PMTCT Guidelines).
Experimental: Study Intervention for Retention (APFU)
Participants randomized to the experimental arm of the study will receive routine antenatal and HIV services as described above per Kenya national guidelines. In addition each newly identified HIV-infected pregnant woman randomized to the experimental arm will be assigned an outreach worker/counselor (Mama Mshauri), who will perform numerous tasks described in the intervention. In addition to the Mama Mshauri, this arm will receive phone/SMS appointment reminders, and default patient tracking if participants miss an appointment.
Behavioral: Study Intervention for Retention (APFU)
Each newly identified HIV-infected pregnant woman randomized to the experimental arm will be assigned an outreach worker/counselor (Mama Mshauri).
Mama Mshauri tasks will include:
Additional intervention components include:
Mother Infant Retention for Health (MIR4HEALTH) is an innovative implementation science study focused on testing an effective multicomponent strategy to improve linkage and retention of newly identified HIV‐infected pregnant women accessing maternal child health (MCH) services in Nyanza Province, Kenya. MIR4HEALTH is distinguished by several innovations including the recognition that newly identified HIV-infected pregnant woman are especially vulnerable to poor retention within PMTCT services and that both mother and child must be retained in care to ensure optimal health outcomes.
The study is a randomized trial to compare the effectiveness of a novel strategy using Active Patient Follow-Up (APFU) to the current standard of care (SOC) routinely provided for the retention of women and their exposed infants postpartum. The proposed APFU includes a package of evidence-based interventions including health education, provision of phone and short message service (SMS) appointment reminders, active tracking of patients for linkage and retention, and individualized retention and adherence support. Patients enrolled in the APFU intervention arm will complete three antenatal study visits after enrollment as well as two postnatal study visits with their infants at 6 weeks and 6 months postpartum. Laboratory blood specimens will be collected from mothers and infants at two separate visits to assess viral load and and drug levels. Additionally, all staff will be offered a chance to participate in an interview assessing the feasibility and acceptability of APFU.
Study participants will be recruited from various clinics in the Nyanza Province in Kenya. This study will enroll pregnant women who test positive for HIV during their first antenatal visit and have no prior HIV diagnosis. Upon live birth, the infants of participating women will also be included in the study. The study will enroll 214 newly-infected pregnant women, with 107 participants in the APFU arm (intervention) and 107 participants in the SOC arm. Infants born to women enrolled in the study will also be included so there will be a total of 214 mother-infant pairs, totaling 428 participants.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01962220
|Ahero Sub-district Hospital|
|Ahero, Nyanza, Kenya|
|Ambira Sub-District Hospital|
|Ambira, Nyanza, Kenya|
|Bondo District Hospital|
|Bondo, Nyanza, Kenya|
|Got Agulu Sub-district Hospital|
|Got Agulu, Nyanza, Kenya|
|Jaramoji Oginga Oginga Referral Hospital|
|Kisumu, Nyanza, Kenya|
|Madiany District Hospital|
|Madiany, Nyanza, Kenya|
|Masogo Sub-district Hospital|
|Masogo, Nyanza, Kenya|
|Nyakatch District Hospital|
|Nyakatch, Nyanza, Kenya|
|Siaya District Hospital|
|Siaya, Nyanza, Kenya|
|Ukwala Health Center|
|Ukwala, Nyanza, Kenya|
|Principal Investigator:||Ruby Fayorsey, MD/MPH||ICAP - Columbia University|
|Principal Investigator:||William Reidy, PhD||ICAP - Columbia University|
|Principal Investigator:||Eluid Mwangi, MD/MPH/MBA||ICAP - Kenya|
|Principal Investigator:||Duncan Chege, PhD||ICAP - Kenya|