Mother Infant Retention for Health: MIR4Health

Study Overview
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Brief Summary
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Linking HIV-infected pregnant women into prevention of mother to child transmission (PMTCT) services and keeping them in care is important in ensuring that both mother and infant beneﬁt from interventions that improve maternal health and decrease HIV transmission to infants. We propose an evaluation of strategies to link newly diagnosed HIV-infected women to care and keep them in care during pregnancy and after delivery in our study called MIR4HEALTH. The study will be conducted in Nyanza Province, Kenya. All participants will provide informed consent and will be randomized to receive the intervention, including individualized patient education, adherence support and phone call/Short Message Service (SMS) reminders for clinic appointments, or the standard of care (no additional intervention services).

Detailed Description
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Mother Infant Retention for Health (MIR4HEALTH) is an innovative implementation science study focused on testing an effective multicomponent strategy to improve linkage and retention of newly identified HIV-infected pregnant women accessing maternal child health (MCH) services in Nyanza Province, Kenya. MIR4HEALTH is distinguished by several innovations including the recognition that newly identified HIV-infected pregnant woman are especially vulnerable to poor retention within PMTCT services and that both mother and child must be retained in care to ensure optimal health outcomes. The study is a randomized trial to compare the effectiveness of a novel strategy using Active Patient Follow-Up (APFU) to the current standard of care (SOC) routinely provided for the retention of women and their exposed infants postpartum. The proposed APFU includes a package of evidence-based interventions including health education, provision of phone and short message service (SMS) appointment reminders, active tracking of patients for linkage and retention, and individualized retention and adherence support. Patients enrolled in the APFU intervention arm will complete three antenatal study visits after enrollment as well as two postnatal study visits with their infants at 6 weeks and 6 months postpartum. Laboratory blood specimens will be collected from mothers and infants at two separate visits to assess viral load and and drug levels. Additionally, all staff will be offered a chance to participate in an interview assessing the feasibility and acceptability of APFU. Study participants will be recruited from various clinics in the Nyanza Province in Kenya. This study will enroll pregnant women who test positive for HIV during their first antenatal visit and have no prior HIV diagnosis. Upon live birth, the infants of participating women will also be included in the study. The study will enroll 214 newly-infected pregnant women, with 107 participants in the APFU arm (intervention) and 107 participants in the SOC arm. Infants born to women enrolled in the study will also be included so there will be a total of 214 mother-infant pairs, totaling 428 participants.

Official Title
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Mother Infant Retention for Health: Evaluation of a Multicomponent Strategy to Link and Retain Newly Identified HIV-infected Pregnant Women and Their Infants Throughout the Antenatal and Post-partum Period

Conditions
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HIV/AIDS

Intervention / Treatment
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* Behavioral: Study Intervention for Retention (APFU)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Documented HIV-infection according to two finger-prick rapid tests (both previously diagnosed and newly detected) Confirmed pregnancy by urine pregnancy test or clinical assessment Age 16 years or older Able to provide informed consent for research Fluent in Luo or English Own a cell phone or have access to one in their households Live born infants of women enrolled in the study Exclusion Criteria: Patients who fail to meet any of the inclusion criteria will be excluded Significant obstetric condition documented at the first antenatal visit requiring urgent referral to another facility for specialized obstetric care (e.g., significant hypertension or active bleeding per vagina). Denial of HIV status or refusal to initiate ART/ARV prophylaxis. Stated intention to move from study site area during the pregnancy or within six months postpartum.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard of Care<br>Routine ANC, Delivery and Postpartum Care: All consenting women will receive routine ANC/Delivery and Postpartum care offered to pregnant women in Kenya as per national guidelines at the MCH of the respective facility. Routine PMTCT and HIV Care: All newly diagnosed HIV-infected pregnant women are enrolled into HIV care in the MCH and receive PMTCT/HIV care per Kenya national guidelines (Revised 2012 PMTCT Guidelines). | |
| Experimental: Study Intervention for Retention (APFU)<br>Participants randomized to the experimental arm of the study will receive routine antenatal and HIV services as described above per Kenya national guidelines. In addition each newly identified HIV-infected pregnant woman randomized to the experimental arm will be assigned an outreach worker/counselor (Mama Mshauri), who will perform numerous tasks described in the intervention. In addition to the Mama Mshauri, this arm will receive phone/SMS appointment reminders, and default patient tracking if participants miss an appointment. | Behavioral: Study Intervention for Retention (APFU)<br>* Each newly identified HIV-infected pregnant woman randomized to the experimental arm will be assigned an outreach worker/counselor (Mama Mshauri). Mama Mshauri tasks will include: Immediately engaging the newly identified pregnant woman, providing individualized adherence and disclosure support, management of ART side effects, and helping the client navigate the health system. Providing tailored individualized health education during home visits. Additional intervention components include: Appointments and Reminders: SMS or telephone reminders 1 week and 3 days before appointments. Reinforcement of importance of follow-up during home visits and every contact. Patient Tracking and Defaulter Tracing: Monthly visits and immediate calls/home visit if she misses an appointment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of mothers and infants non-retained in care at 6 months | Mother/infant attrition at 6 months postpartum | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of women completing the 2nd ANC visit and all ANC and PN visits | Completion ANC and PN visits | 6 months | 
| Proportion of women who had a hospital delivery | Hospital delivery | 6 months | 
| Proportion of infants receiving PCR testing at 6 weeks of age and 6 months | Infant PCR testing | 6 months | 
| Proportion of male partners receiving HIV testing | Male Partner HIV tests | 12 months | 
| Proportion of infants exclusively breastfeeding at 6 months and number of months infant spent breastfeeding | Exclusive Breastfeeding | 6 months | 
| Change in CD4+ cell count from study enrollment to 6 month postpartum for women | CD4+ Cell Count | 12 months | 
| Proportion of women with undetectable HIV RNA at delivery and 6 months postpartum | Undetectable Viral RNA | 12 months | 
| Proportion of women adherent to ARV regimen during pregnancy and postpartum period | Mother ARV Adherence | 12 months | 
| Proportion of infants adherent to postnatal ARV regimen during first six weeks of life | Infant ARV Adherence | 1.5 months | 
| Proportion of women & staff reporting APFU highly acceptable | Intervention Acceptability | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV/AIDS, PMTCT, Pregnant Women, Kenya, Maternal Health