Evidence map›Paper›PMID 31416459›Full record

Trial reportTrials2019

Impact of the Umoyo mother-infant pair model on HIV-positive mothers' social support, perceived stigma and 12-month retention of their HIV-exposed infants in PMTCT care: evidence from a cluster randomized controlled trial in Zambia.

Sydney Chauwa Phiri, Sandra Mudhune, Margaret L Prust, Prudence Haimbe, Hilda Shakwelele, Tina Chisenga, Mwangelwa Mubiana-Mbewe, Maureen Mzumara, Elizabeth McCarthy, Marta R Prescott

Open access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Trials, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.

  1. Strategies to improve retention in randomised trials.The Cochrane database of systematic reviews · 2021
    Pooled it
  2. Article
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Sydney Chauwa PhiriClinton Health Access Initiative, Lusaka, Zambia. sydnyhill@gmail.com.ORCID http://orcid.org/0000-0002-8415-9515
Sandra MudhuneClinton Health Access Initiative, Lusaka, Zambia.
Margaret L PrustClinton Health Access Initiative, Boston, MA, USA.
Prudence HaimbeClinton Health Access Initiative, Lusaka, Zambia.
Hilda ShakweleleClinton Health Access Initiative, Lusaka, Zambia.
Tina ChisengaMinistry of Health Zambia, Lusaka, Zambia.
Mwangelwa Mubiana-MbeweCenter for Infectious Disease Research in Zambia, Lusaka, Zambia.
Maureen MzumaraCenter for Infectious Disease Research in Zambia, Lusaka, Zambia.
Elizabeth McCarthyMinistry of Health Zambia, Lusaka, Zambia.
Marta R PrescottClinton Health Access Initiative, Boston, MA, USA.
Clinton Health Access Initiative · USCentre for Infectious Disease Research in Zambia · ZMMinistry of Health · ZM

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPublic health systems in resource-constrained settings have a critical role to play in the elimination of HIV transmission but are often financially constrained. This study is an evaluation of a mother-infant-pair model called "Umoyo," which was designed to be low cost and scalable in a public health system. Facilities with the Umoyo model 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. This work establishes whether the Umoyo model would improve 12-month retention of HEIs.

methodsA cluster randomized trial including 28 facilities was conducted across two provinces of Zambia to investigate the impact on 12-month retention of HEIs in care. These facilities were offering Prevention of Mother-to-Child-Transmission (PMTCT) services and supported by the same implementing partner. Randomization was achieved by use of the covariate-constrained optimization technique. 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 the unweighted t test.

resultsFrom 13 control (12-month retention at endline: 45%) and 11 intervention facilities (12-month retention at endline: 33%), 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 (0.31; 99% CI 0.08, 0.54) and reducing perceived stigma from health care workers (- 0.27; 99% CI - 0.46, - 0.08).

conclusionThe 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 registrationPan African Clinical Trial Registry, ID: PACTR201702001970148 . Prospectively registered on 13 January 2017.

Indexed as

Pregnancy Complications, InfectiousSocial StigmaSocial SupportCluster AnalysisFemaleHIV InfectionsHumansInfantInfectious Disease Transmission, VerticalPregnancyResearch DesignHIV-exposed infantMother-infant pair clinicRetentionSocial supportStigma

Identifiers

PMID31416459
PMCPMC6694552
OpenAlexW2967687714

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.