The Impact of Mentor Mothers on PMTCT Service Outcomes in Nigeria (MoMent)

• Proportion of HIV-exposed infants receiving DNA PCR test as early infant HIV diagnostic. [ Time Frame: When HIV-exposed infant is 2 months old ] [ Designated as safety issue: No ]
  Early infant diagnosis (EID) is defined as the performance of an HIV DNA PCR test for an HIV-exposed infant by 2 months of age. EID is done to ensure that HIV-positive infants will be promptly enrolled into HIV treatment programs and can start lifesaving Highly Active Antiretroviral Therapy (HAART) in timely fashion. Late collection of DNA PCR for an HIV-exposed child may allow for late diagnosis of HIV, and delayed initiation of ART. This may lead to increased infant morbidity and mortality, which is undesirable in any PMTCT or Maternal Child Health program.
  
  

• Proportion of HIV+ mothers who were HAART-adherent during period of HAART eligibility. [ Time Frame: From study enrollment until end of breastfeeding period (or at end of study-when infant is 12 months old) ] [ Designated as safety issue: No ]
  We will measure proportion of HIV+ women who are > 95%, >80 to 95%, and < 80%-adherent during HAART eligibility periods pre- and post-delivery.
  
  
• Proportion of exposed infants who complete 6 weeks of Nevirapine prophylaxis [ Time Frame: When exposed infant is 6 weeks of age ] [ Designated as safety issue: No ]
  In addition to starting early, successful Nevirapine prophylaxis also requires the completion of the recommended 6 week course.
  
  
• Proportion of exposed infants who receive first dose of Nevirapine (NVP) syrup prophylaxis within 72 hrs of life [ Time Frame: When exposed infant is 72 hrs (3 days) old ] [ Designated as safety issue: No ]
  NVP, given as post-exposure prophylaxis to an exposed infant, is to be administered within 72 hrs. A delay in administering the first dose of NVP beyond 72 hrs may increase the risk of mother-to-child transmission of HIV.
  
  
• Proportion of HIV+ mothers who exclusively breastfed for 6 months [ Time Frame: When exposed infant is 6 months old ] [ Designated as safety issue: No ]
  We will assess the proportion of HIV+ mothers who fed their infants breastmilk only, for the first 6 months. Mixed feeding (breastmilk with formula milk) poses a higher risk of mother-to-child-transmission of HIV.
  
  
• Proportion of Mother-Infant Pairs who were retained in PMTCT services at 12 months postdelivery [ Time Frame: When exposed infant is 12 months old ] [ Designated as safety issue: No ]
  We will assess retention through appointments kept by the Mother-Infant Pair from time of delivery until 12 months postdelivery. A minimum of 6 appointments are expected, including the post-weaning test appointment for HIV-negative babies.
  
  
• Proportion of HIV-exposed infants who received post-weaning HIV test [ Time Frame: 6 weeks postweaning; maximum 12 months + 6 weeks postdelivery ] [ Designated as safety issue: No ]
  All HIV-exposed infants who initially tested HIV negative at 6 weeks of age, and are still breastfeeding, will receive a second HIV test 6 weeks after weaning from breastmilk. The recommended time for complete weaning is 12 months of age, although some infants are weaned before this time. Making the appointment for this follow-up test is an important determinant of retention in PMTCT care for the mother-infant pair.
  
  

Nigeria has had a national HIV/AIDS care and treatment program in place since 2003. Included in this national program are preventive sub-programs; the largest of which is the prevention-of-mother-to-child transmission (PMTCT) program. Despite almost 10 yrs of providing PMTCT, Nigeria still has significant problems with uptake of, and retention in these services. These problems translate into only 10-20% of HIV+ pregnant women receiving Anti-Retroviral Drug (ARV) prophylaxis, and the highest pediatric HIV burden of any country in the world.

Mentor Mothers (MM) are women living with HIV who are experienced users and navigators of HIV service delivery, particularly PMTCT. The idea to employ these women's experience in bringing other HIV+ (especially pregnant) women into HIV care and PMTCT services originated in South Africa, and has been adopted and applied in several African countries. MM programs have also been adopted and utilized in Nigeria, especially by the Institute of Human Virology Nigeria (IHVN); however, large studies and objective measurements of their impact on PMTCT service uptake and retention have not been carried out in Nigeria.

The investigators are conducting an impact evaluation study of MM in Nigeria, focusing on two North-Central states, the Federal Capital Territory and Nasarawa. The research team has specifically developed a rigorous, yet trainee-appropriate, standardized training curriculum for MoMent study MM. The choice of Primary Healthcare Facilities in which to conduct this study is intentional; these sites are located in hard-to-reach-areas where a significant number of PMTCT-eligible clientele live. The investigators expect this strategy to improve visibility, acceptability, access and retention of PMTCT services in rural areas.