Horizons Projects | Community-based Approaches to Preventing Mother-to-Child Transmission of HIV

HORIZONS PROJECT
Community-based Approaches to Preventing Mother-to-Child Transmission of HIV

The Horizons program, in partnership with International Medical Corps and Steadman Research Services International, is conducting an operations research study to compare three different community-based approaches in Kibera, a densely settled urban slum in Nairobi, Kenya, and to analyze the cost-effectiveness of each in increasing women’s use of services to prevent mother-to-child transmission of HIV (PMTCT). The strategies include (1) moving PMTCT services closer to the population via a mobile clinic, and increasing psychosocial support for HIV-positive women through the use of (2) traditional birth attendants and (3) peer counselors. All three approaches are supported by health information campaigns to increase public knowledge about vertical HIV transmission, promote PMTCT services, and reduce stigma and discrimination.

The effectiveness of these strategies will be measured by comparing baseline to follow-up, cross-sectional data. At baseline (2004), the researchers conducted exit interviews with women ten weeks' or less postpartum.

Findings from the baseline data about family planning include:

HIV-positive women are significantly more likely than HIV-negative women to say that they do not intend to have more children.
Many women had not discussed family planning with a provider during antenatal care.
Providers give directive counseling for HIV-positive women, that is, they encourage use of family planning and discourage having more children.
Postpartum family planning use is similar for HIV-positive and HIV-negative women.
Most HIV-positive and HIV-negative women intend to use contraceptives in the future and view several methods favorably.
Multiple factors influence how HIV-positive women decide to use family planning.
Women identified side effects as a major reason to not use family planning.
Although being HIV-positive inhibits partner communication, the vast majority of HIV-positive women felt they could talk about HIV and family planning with their partner.

Key findings on infant feeding counseling and practice include:

Many women do not receive infant feeding counseling; however, HIV-positive women were more likely to have received infant feeding counseling than HIV-negative women or women of unknown HIV status.
HIV-positive women were more likely to have practiced exclusive breastfeeding and reported higher levels of MTCT transmission knowledge; they were less likely to have practiced mixed feeding than their counterparts.

Final results on the impact of the interventions are expected in August 2007.

Location

Kibera slum and Dagoretti, Nairobi, Kenya

Duration

May 2004–April 2007

Horizons and Population Council researchers

Scott Geibel, Carolyn Baek, Susan Cherop-Kaai, Naomi Rutenberg

Non-Council collaborators

Centers for Disease Control and Prevention

Barbara Janowitz (Family Health International)

Peter McOdida, Ulo Benson (International Medical Corps)

Carol N’katha-Matiko (Steadman Research Services International)

Donor

US Agency for International Development

Publications/Resources on this project