In 2015, UCLA, Partners in Hope (PIH) Medical Center in Malawi, and the University of Witwatersrand in South Africa joined with the Hilton Foundation on a two-year pilot program to assess the feasibility and acceptability, as well as initial outcomes, of supporting Option B+ mothers in Malawi. The program focused on Option B+ mothers in recognition of the fact that these mothers have numerous vulnerabilities in addition to their HIV infection. The pilot work further defined and documented these vulnerabilities, including lack of partner support, struggles with paying for transport and providing proper nutrition to their children, and community level stigma and discrimination. The focus on HIV-exposed infants was in line with studies suggesting an increased risk of developmental delays among HIV-exposed uninfected children. Additionally, like their mothers, HIV-exposed infants face increased vulnerability in nearly every aspect of life, particularly in the environment of extreme poverty that exists in rural Malawi.
From 2015-2017, the pilot worked with mother-infant pairs at two district hospital sites in Malawi- Kasungu and Nkhotakota. Mothers were enrolled in once per month ECD sessions for 10 months, timed to coincide with the women’s ART refill dates. From April to December 2016, 161 mother-infant pairs were enrolled in the program. 95 (59%) of pairs remained active in both ECD sessions and in their HIV care. Of the 47 (24%) infants classified with moderate developmental delays at baseline, 44 (94%) moved to normal development at follow-up. Home visits showed that over 90% of infants had appropriate stimulation and communication from caregivers outside of clinic settings. Exit interviews with the mothers indicated strong satisfaction with the program and a keen interest in continuing with ECD activities in their communities.
Under the new grant, PIH will expand access to ECD training in clinics at nine health centers and seven hospitals in Lilongwe District, and expand to additional facilities in the original two districts (Kasungu and Nkhotakota). Building upon PIH’s existing infrastructure, the project will make use of Expert Clients to support mothers and their infants. Expert Clients are HIV+ individuals who provide support to community members to support disclosure, retention, and prevention. Under the grant, an additional 80 Expert Clients and 20 Lead Expert Clients will be trained on ECD/Option B+ integration.
The project will also incorporate a cost-benefit analysis of the integrated ECD/Option B+ model and identify the most cost effective method to deliver ECD and Option B+ in a low resource, high HIV prevalence setting, such as Malawi. The cost data will be used in advocacy efforts with the government around the cost-benefit of adding ECD into standard health programs as part of the national strategy.
Other faculty involved in the project are Alan Schooley, MD, (Clinical Co-Director and Supervisor for Central Region, EQUIP Malawi Project), Kathryn Dovel, PhD (Associate Research Director, Partners in Hope), Linda Richter, PhD (Distinguished Professor and Director, DST-NRF Centre of Excellence in Human Development at University of the Witwatersrand), and Laurie Bruns (Senior Regional Africa Director, UCLA Center for World Health).