Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Jul 11;15 Suppl 2(Suppl 2):17373.
doi: 10.7448/IAS.15.4.17373.

Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review

Joanna Busza  1 , Damilola Walker, Alana Hairston, Alicia Gable, Christian Pitter, Stephen Lee, Leila Katirayi, Rogers Simiyu, Daphne Mpofu
Affiliations
Review

Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review

Joanna Busza et al. J Int AIDS Soc. .

Abstract

Introduction: Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain.

Methods: First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries.

Results: Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as "community mobilization" remain poorly defined.

Conclusions: Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Basic HIV treatment cascade.
Figure 2
Figure 2
Social ecological framework for determinants of uptake, adherence and retention in PMTCT.
See this image and copyright information in PMC

References

    1. Padian NS, McCoy SI, Karim SS, Hasen N, Kim J, Bartos M, et al. HIV prevention transformed: the new prevention research agenda. Lancet. 2011;378(9787):269–78. - PMC - PubMed
    1. Bajunirwe F, Muzoora M. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda. AIDS Res Ther. 2005;2(1):10. - PMC - PubMed
    1. Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care Panel. Ann Intern Med. 2012:E-419. - PMC - PubMed
    1. Ciaranello A, Park JE, Ramirez-Avila L, Freedberg KA, Walensky RP, Leroy V. Early infant HIV-1 diagnosis programs in resource limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Med. 2011;9(1):59. - PMC - PubMed
    1. Coutsoudis A, Kwaan L, Thomson M. Prevention of vertical transmission of HIV-1 in resource-limited settings. Expert Rev Anti Infect Ther. 2010;8(10):1163–75. - PubMed

MeSH terms