Abstract #378  -  Project Masihambisane (An information and support programme for women and their children in PMTCT programmes delivered by HIV-positive peer mentors during pregnancy and post-partum): Information needs and disclosure.
Authors:   Presenting Author:   Mr Alastair van Heerden - Human Sciences Research Council
Additional Authors:  dr. Heidi van Rooyen, dr. Linda Richter, dr. Mary-Jane Rotheram,
Aim: HIV infection in pregnant women raises a number of issues that are not faced by men or non -pregnant women. These include the risk of HIV transmission to their infant, negative developmental outcomes for the infant, health risks for herself and social and behavioural challenges, such as disclosure, adherence, choice and maintenance of a feeding option, and so on. Project Masihambisane is a matched clinic effectiveness trial to test an intervention to improve the health and wellbeing of mothers living with HIV (MLH) and their babies in a prevention-of-mother-to-child-transmission (PMTCT) service provided by the public sector in a very high HIV prevalence area in South Africa.
Method / Issue: The intervention consists of a clinic-based mentor mother-led group peer support programme, accompanied by dissemination of information for the promotion of the health and wellbeing of MLH and their children. As a supplement to PMTCT, the intervention is being tested in eight primary health care clinics in KwaZulu-Natal, South Africa. The clinics are paired through matching of salient features, such as client load, range of services offered, and rural-urban setting. Four clinic pairs were randomised to the intervention and 4 to the control condition. Mothers living with HIV in control clinics receive the Department of Health (DoH) standardized PMTCT programme. In the intervention clinics, MLH receive the standard of care PMTCT programme, supplemented by the Masihambisane intervention.
Results / Comments: During the first 12 months of enrolment, 760 HIV-positive pregnant women completed a baseline assessment. Exploratory analysis of the baseline data offers insight into mothers’ knowledge about transmission prevention and their capacity to deal with issues such as disclosure and stigma. Two thirds of the cohort report knowing about the medication that needs to be taken to prevent vertical transmission. For those who claim to know, further analysis elicited a high number of correct responses around the antenatal AZT short course treatment (92%), onset of AZT treatment (92.6%), dose (82.3%) and duration (86.4%). Knowledge of AZT administration during labour was more limited (51%), as was information about how to prevent transmission post-partum (43%). Disclosure remains a barrier to further prevention and support for MLH, with only one third of the sample (36.8%) indicating that they would be able to disclose their HIV status if they wanted to. Of these women, the majority (69.8%) had told their partner and most often their disclosure was met with a positive response.
Discussion: Although women frequently report being knowledgeable about PMTCT, it is clear that some elements of the PMTCT protocol are better understood than others. In particular, attention should be paid to the post-partum period of the dual therapy regime, support for feeding choices and self-care. Further, with two thirds of the sample indicating that that they either could not or were unsure whether they could disclose their status, disclosure and stigmatisation remain very real barriers to the successful implementation of PMTCT and the provision of ongoing support for MLH and their children. The paper concludes with illustrations of the way in which Project Masihambisane attempts to address these issues.
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