Developing an enhanced Mentor Mother strategy to improve prevention of mother-to-child transmission of HIV (PMTCT) outcomes

Prevention of mother-to-child transmission of HIV (PMTCT) programs offer a range of services to women living
with HIV (WLHIV) to maintain their health and minimize the risk of their HIV-exposed infants (HEI) acquiring
HIV. Despite widespread implementation of PMTCT services in sub-Saharan Africa, only two-thirds of WLHIV
are virally suppressed, and nearly 40% of HEI are lost to follow-up or die by 18 months of age. There is a
critical need to develop person-centered strategies targeting the factors preventing WLHIV and their HEI from
realizing the full benefits of PMTCT care. Mentor Mothers (MM) are peer advocates who support WLHIV and
HEI to promote improved PMTCT outcomes. While MM show promise in this regard, it is clear a “one size fits
all” approach lacks responsiveness to the fact that some WLHIV and HEI need minimal support while others
have specific needs. Research is needed to understand what strategies MM can use to address factors known
to influence PMTCT outcomes, and how best to implement these strategies with high-fidelity in real-world
settings. This proposal aims to address knowledge gaps and promote optimal PMTCT outcomes through
person-centered development of an enhanced MM strategy that focuses on both the specific problems faced
by WLHIV and HEI, as well as the real-world constraints of PMTCT programs. The central hypothesis is that
this enhanced MM strategy can be implemented with high acceptability and fidelity, resulting in improved
PMTCT outcomes. We will test this hypothesis through research targeted to the following Specific Aims. AIM 1:
Use a participatory research approach to develop an enhanced MM strategy. In Sub-Aim 1a we will perform
qualitative interviews with MM and WLHIV (both those with and without unfavorable PMTCT outcomes
[attrition, viremia, or vertical transmission]) to identify: (i) feasible enhancements to the current MM strategy, (ii)
barriers to optimizing the MM strategy, and (iii) approaches to overcoming these barriers. In Sub-Aim 1b we
will conduct participatory design workshops with key implementation stakeholders (MM, PMTCT program
leadership, and clinic staff) to develop an enhanced MM strategy with optimal potential for sustainable
implementation. AIM 2: Conduct a pilot hybrid type 3 implementation-effectiveness study of the enhanced MM
strategy. The enhanced MM strategy will be implemented at one clinic. We will use a mixed-methods approach
to thoroughly assess acceptability, feasibility, and fidelity to the enhanced MM strategy. A pre-post assessment
of key PMTCT outcome measures will provide preliminary effectiveness data. We expect this K23 proposal to
advance my expertise in HIV implementation science, qualitative and mixed-methods research, and person-
centered participatory design while also generating the compelling preliminary data needed to support a future
R01 application for a pragmatic cluster randomized clinical trial of the enhanced MM strategy. These K23
research and career development activities will culminate in my transition to independence as an R01-funded,
physician-scientist.

Grant Number: 5K23HD109056-04
NIH Institute/Center: NIH
Principal Investigator: JAMES CARLUCCI