Impact of Umoyo mother-infant pair clinics on HIV-positive mothers’ social support, perceived stigma and 12-month retention of their HIV-exposed infants in PMTCT Care: Evidence from a cluster randomised control trial in Zambia

Background Public health systems in resource constrained settings have a critical role to play in the elimination of vertical HIV transmission but are unable to carry out some of the promising interventions such as mother-to-mother peer support programs due to financial constraints. This study is an evaluation of a mother-infant-pair clinic called Umoyo, which was designed to be scalable in a public health system due to the relatively low costs required. Umoyo clinics dedicate a clinic day to provide services to only HIV-exposed-infants (HEIs) and their mothers. Such models are in operation with reported success in Zambia but have not been rigorously tested. Methods A cluster randomized trial including 28 facilities was conducted across two provinces of Zambia to investigate 12-month retention of HEIs in care. These were facilities that were offering prevention of mother to child transmission (PMTCT) services and supported by the same implementing partner. Random allocation was achieved by use of the covariate constrained optimization technique. The primary outcome of interest was to establish whether Umoyo clinic days would improve 12-month retention of HEIs. Secondary outcomes included the impact of Umoyo clinics on social support and perceived HIV stigma among mothers. For each of the outcomes, a difference-in-difference analysis was conducted at the facility level using unweighted t-test. Results From 13 control and 11 intervention facilities, it was found that Umoyo clinics had no impact on 12-month retention of HEIs in the t-test (-11%; 99% CI: -40.1%, 17.2%). Regarding social support and stigma, the un-weighted t-test showed no impact though sensitivity tests showed that Umoyo had an impact on increasing social support and reducing perceived stigma from health care workers. Conclusion The Umoyo approach of having a dedicated clinic day for HEIs and their mothers did not improve retention of HEIs though there are indications that it can increase social support among mothers and reduce stigma. Without further support to the underlying health system, based on the evidence generated through this evaluation, the Umoyo clinic day approach on its own is not considered an effective intervention to increase retention of HIV-exposed infants.Trial Registration Pan African Clinical Trial Registry (PACTR201702001970148) Prospectively registered on January 13, 2017. URL https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1970