Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV

As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH).Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges.ClinicalTrials.gov registration # NCT00972699An estimated 1.4 million pregnant women are women living with HIV (WLH) in low and middle income countries (LMIC) [1]. South Africa has the highest total number of people living with HIV (5.7 million), of whom 3.2 million are women [1] and more than 200,000 are pregnant WLH in need of antiretrovirals [2]. The national HIV prevalence has stabilised around 11% [3], with the highest rates in the Kwa-Zulu-Natal and Gauteng Provinces. Up to 40-60% of pregnant women in Kwa-Zulu-Natal are HIV positive [4]. Antiretroviral (ARV) medications can reduce HIV transmission to less than 2% at childbirth and exclusive breastfeeding for six months also minimizes risk of transmission [5]. Therefore, effective programs to prevent mother-to-child transmission (PMTCT) for WLH in South Africa are urgently needed.The goal of this cluster randomized controlled trial (RCT) is to evaluate a clinic-based strategy for increasing uptake of PMTCT and to improve maternal health behaviors over time. The Masihambisane program is leveraging the unique intervention opportunities created