Table 3 Family-centred PMTCT intervention models: Comprehensive Services
From: Family-centred approaches to the prevention of mother to child transmission of HIV
Citation, country, sample size | Design | Target group | Family-centred PMTCT programme components | Outcomes | Study limitations |
|---|---|---|---|---|---|
[27] Abrams et al, 2007; 8 countries in sub- Saharan Africa and southeast Asia; roughly 12,000 individuals | Observational cohort | HIV-infected pregnant women and their families | As part of the MTCT-Plus Initiative, women receiving prevention of mother to child transmission (PMTCT) services were invited to enrol in MTCT- Plus, a comprehensive HIV care programme, along with their newborn infants, as well as HIV+ family and household members | More than 2/3 of index women enrolled their HIV-exposed baby or an HIV-infected family member Retention of participants was very high, with fewer than 600 adults leaving the programme, including 190 reported deaths More than 2000 infants, 90% of those who reached 18 months, were determined uninfected, and of the 761 infected children enrolled, 65% received highly active antiretroviral therapy (HAART) | The feasibility of linking the different services represented in this model may be hindered in other contexts by factors like resource constraints, human capacity and community preferences |
[26] Geddes et al, 2008; South Africa; 2624 women | Prospective cohort | Families | PMTCT integrated into antenatal services Women were encouraged to bring partners for HIV counselling and testing Psychological services provided for discordant couples Cluster of differentiation 4 (CD4) counts measured to determine appropriate form of ART and mode of delivery Polymerase chain reaction (PCR) test given to HIV-exposed infants; HIV+ babies were enrolled in children's programme | During 18 months, 100% of women attending the clinic received counselling 91% of women and 25% of partners were tested for HIV In 338 cases of maternal HIV+, 70% of live births were by caesarean section and 98% of live babies were given nevirapine; 76% also received azidothymidine. Of the 81% of babies tested at 6 weeks (via PCR), 2.9% tested positive | May have been subject to selection bias - 11% of mothers lost to follow up Participants may have been socioeconomically and educationally better off than others who attended public facilities |
[28, 29] Mermin, 2005; rural Uganda; more than 6000 family members | Prospective cohort | Families | VCT for HIV extended to more than 6000 family members of HIV+ individuals Distribution of cotrimoxazole prophylaxis and a home-based water purification systems Future support for additional home-based delivery of ART for more than 4000 individuals | >95% of family members accepted VCT; 35% of married HIV+ individuals discovered they were living with an HIV- spouse Cotrimoxazole prophylaxis taken by HIV+ individuals was associated with a 46% reduction in mortality The water purification system was associated with a 25% reduction in diarrhoea among persons with HIV | Data were acquired mainly from a 2005 conference abstract and therefore have not been subjected to peer review |