The Tingathe programme

A pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi

Maria H. Kim, Saeed Ahmed, W. Chris Buck, Geoffrey A. Preidis, Mina C. Hosseinipour, Avni Bhalakia, Debora Nanthuru, Peter N. Kazembe, Frank Chimbwandira, Thomas P. Giordano, Elizabeth Y. Chiao, Gordon E. Schutze, Mark W. Kline

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Introduction: Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants.We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. Methods: PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. Results: Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART. Conclusions: Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.

Original languageEnglish (US)
Article number17389
JournalJournal of the International AIDS Society
Volume15
DOIs
StatePublished - Jul 11 2012
Externally publishedYes

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Malawi
Continuity of Patient Care
Mothers
HIV
Polymerase Chain Reaction
Pregnant Women
Maternal Death
Fetal Death
Prenatal Care
Sulfamethoxazole Drug Combination Trimethoprim
Maternal Age
Case Management
Live Birth
Logistic Models

Keywords

  • Community engagement
  • Community health workers
  • Early infant diagnosis (EID)
  • HIV
  • Loss to follow up
  • Paediatric HIV
  • Prevention of mother to child transmission (PMTCT)
  • Retention
  • Task shifting

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

Cite this

The Tingathe programme : A pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi. / Kim, Maria H.; Ahmed, Saeed; Buck, W. Chris; Preidis, Geoffrey A.; Hosseinipour, Mina C.; Bhalakia, Avni; Nanthuru, Debora; Kazembe, Peter N.; Chimbwandira, Frank; Giordano, Thomas P.; Chiao, Elizabeth Y.; Schutze, Gordon E.; Kline, Mark W.

In: Journal of the International AIDS Society, Vol. 15, 17389, 11.07.2012.

Research output: Contribution to journalArticle

Kim, MH, Ahmed, S, Buck, WC, Preidis, GA, Hosseinipour, MC, Bhalakia, A, Nanthuru, D, Kazembe, PN, Chimbwandira, F, Giordano, TP, Chiao, EY, Schutze, GE & Kline, MW 2012, 'The Tingathe programme: A pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi', Journal of the International AIDS Society, vol. 15, 17389. https://doi.org/10.7448/IAS.15.4.17389
Kim, Maria H. ; Ahmed, Saeed ; Buck, W. Chris ; Preidis, Geoffrey A. ; Hosseinipour, Mina C. ; Bhalakia, Avni ; Nanthuru, Debora ; Kazembe, Peter N. ; Chimbwandira, Frank ; Giordano, Thomas P. ; Chiao, Elizabeth Y. ; Schutze, Gordon E. ; Kline, Mark W. / The Tingathe programme : A pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi. In: Journal of the International AIDS Society. 2012 ; Vol. 15.
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abstract = "Introduction: Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70{\%}. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants.We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. Methods: PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. Results: Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7{\%}) were already on ART. Among the remaining women, 1328/1355 (98{\%}) received a CD4 test, with 1243/1328 (93.6{\%}) receiving results. Of the 499 eligible for ART, 363 (72.8{\%}) were successfully initiated. Prior to, delivery there were 93 (5.7{\%}) maternal/foetal deaths, 137 (8.1{\%}) women transferred/moved, 51 (3.0{\%}) were lost and 58 (3.4{\%}) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9{\%}) of the mothers and 1285 (97.5{\%}) of the infants received ARV prophylaxis; 1064 (80.7{\%}) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1{\%}). Of the 43 infants with positive PCR results, 36 (83.7{\%}) were enrolled in ART clinic and 33 (76.7{\%}) were initiated on ART. Conclusions: Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.",
keywords = "Community engagement, Community health workers, Early infant diagnosis (EID), HIV, Loss to follow up, Paediatric HIV, Prevention of mother to child transmission (PMTCT), Retention, Task shifting",
author = "Kim, {Maria H.} and Saeed Ahmed and Buck, {W. Chris} and Preidis, {Geoffrey A.} and Hosseinipour, {Mina C.} and Avni Bhalakia and Debora Nanthuru and Kazembe, {Peter N.} and Frank Chimbwandira and Giordano, {Thomas P.} and Chiao, {Elizabeth Y.} and Schutze, {Gordon E.} and Kline, {Mark W.}",
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T2 - A pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi

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AU - Ahmed, Saeed

AU - Buck, W. Chris

AU - Preidis, Geoffrey A.

AU - Hosseinipour, Mina C.

AU - Bhalakia, Avni

AU - Nanthuru, Debora

AU - Kazembe, Peter N.

AU - Chimbwandira, Frank

AU - Giordano, Thomas P.

AU - Chiao, Elizabeth Y.

AU - Schutze, Gordon E.

AU - Kline, Mark W.

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N2 - Introduction: Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants.We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. Methods: PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. Results: Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART. Conclusions: Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.

AB - Introduction: Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants.We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. Methods: PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. Results: Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART. Conclusions: Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.

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KW - Early infant diagnosis (EID)

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KW - Prevention of mother to child transmission (PMTCT)

KW - Retention

KW - Task shifting

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