Antenatal Health Care Utilization, Infant Feeding Practices, Postnatal Health Care Utilization, Prevention of Mother-to-child Transmission of HIV
Conditions
Keywords
community health workers, HIV, PMTCT, antenatal, postnatal, breastfeeding, South Africa
Brief summary
This is a cluster randomized controlled trial (C-RCT) to evaluate the effectiveness of a Community-Integrated Management of Childhood Illness (C-IMCI) training for community caregivers (CCGs), adapted to include HIV-related interventions, on the delivery of maternal, newborn and child health interventions within households in rural communities in Ugu District, KwaZulu-Natal (KZN) Province, South Africa. The intervention includes two components: (1) a 2-week HIV/C-IMCI training for CCGs and their associated facilitators and supervisors, and (2) continuous support and supervision following the continuous quality improvement (CQI) framework, a low-technology approach to management and supervision of health programs. The primary objectives of the proposed evaluation are to measure the effect of the intervention on key outcomes, including early uptake of antenatal care, facility based delivery, postnatal visits, coverage of exclusive breastfeeding, and uptake of HIV PCR testing in infants at 6 weeks. We will also examine the effects of the intervention on immunization uptake up to 12 months and knowledge and practices of CCGs and mothers pertaining to maternal, newborn and child health.
Interventions
BEHAVIORALEnhanced HIV and MCH training for CHW
Sponsors
Centers for Disease Control and Prevention
World Health Organization
Institute for Healthcare Improvement
University of California, San Francisco
University of KwaZulu
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Community caregivers * CCGs who work in Ugu District * age 18 years or older * with grade 9 education or greater Mothers * Mothers age 18 years and older who delivered a live-born infant within the prior 12 months * Reside in households served by participating CCGs.
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Prevalence of exclusive breast-feeding practice at 14 weeks | 1 year |
| Coverage of HIV PCR testing at 6 weeks | 1 year |
| Prevalence of antenatal booking before 20 weeks gestation | 1 year |
| Prevalence of presentation for post-natal care within 7 days of delivery | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Proportion of women who attended for antenatal care at least 4 times in pregnancy | 1 year |
| Proportion of deliveries by skilled birth attendant at a health facility | 1 year |
| Proportion of age-eligible infants who received recommended immunizations at 6, 10, and 14 weeks and 9 and 12 months | 1 year |
| Proportion of children whose growth was monitored by CCG at home | 1 year |
| Prevalence of exclusive breast-feeding practice at 6 months | 1 year |
| Proportion of women without known HIV-positive status who received HIV test in pregnancy | 1 year |
| Proportion of women without known HIV-positive status who received HIV test result in pregnancy | 1 year |
| Proportion of HIV-positive women who received CD4 test results | 1 year |
| Proportion of HIV-positive women who received ARV prophylaxis in pregnancy and during delivery | 1 year |
| Proportion of infants born to HIV-positive mothers who received ARV prophylaxis following birth (including during breastfeeding where appropriate) | 1 year |
| Knowledge and practices of mothers in the community regarding: infant feeding, HIV, availability of interventions to reduce HIV transmission, newborn care practices and recognition of serious illness in children and management of childhood illnesses | 1 year |
| Knowledge and practices of CCGs with regards to: HIV-specific interventions to improve maternal health, reduce HIV transmission and improve child survival | 1 year |
Countries
South Africa
Outcome results
None listed