Key Findings from an Evaluation of the mothers2mothers Program in KwaZulu-Natal, South Africa

This 27-page evaluation report shares findings from an evaluation of mothers2mothers (m2m), a peer support programme designed to provide education and psychosocial support to HIV-positive pregnant women and new mothers, help women access existing health care services to prevent mother-to-child transmission of HIV (PMTCT), and follow up to ensure mothers and babies receive appropriate medical care after delivery. The Horizons Program of the Population Council, in collaboration with Health Systems Trust, completed this first evaluation of m2m, which suggests that m2m plays an important role in providing a continuum of care for HIV-positive women and infants.

The evaluation found that the programme achieved substantial coverage of both pregnant and postpartum women, with almost 60% of women reporting that a mentor mother talked with them at least once while the women were pregnant or during their last pregnancy. Nearly half of all pregnant and postpartum women interviewed reported 2 or more interactions with a mentor mother.

With respect to mother-to-child transmission (MTCT) knowledge, overall respondents knew more basic information about how and when MTCT occurs, than how to prevent it. Comparing the 2 groups, m2m participants had greater MTCT knowledge than non-participants, but most differences were not statistically significant.

The evaluation found that there were high rates of disclosure in the study population. Among postpartum women, m2m participants were significantly more likely to have disclosed to someone than non-participants were (97% vs. 85%), and to have done so prior to delivery. Programme participants interviewed postpartum reported significantly higher rates of having undergone CD4 testing during their last pregnancy (79% vs. 57%) and knowing their CD4 count after testing (88% vs. 72%) than non-participants.

The vast majority (70%) of postpartum programme participants (4-12 weeks after delivery) reported using contraception, with injection mentioned as the most common method. They were more likely to use contraception than non-participants.

With respect to psychosocial well-being, pregnant participants were significantly more likely to report feeling they could do things to help themselves, cope with taking care of the baby, and live positively in comparison to non-participants. Postpartum participants reported feeling less alone in the world, overwhelmed by problems, and hopeless about the future compared to non-participants. The multivariate analysis controlled for age, existence of partner, education, employment, number of live births, number of antenatal care visits, and research site. With these controls, programme participation continued to be positively and significantly related to key PMTCT knowledge and behaviours, or there was a positive association that was not statistically significant.

The data were also analysed to assess whether the changes associated with programme participation among postpartum women occurred between baseline and follow-up data collection. Most findings were in the same direction, suggesting that the programme contributed to positive changes at the site level after one year of implementation.

The evaluation concluded that compared to non-participants, m2m participants had greater psychosocial well-being, greater use of PMTCT services, and better PMTCT outcomes. Postpartum participants had more positive changes than pregnant participants, suggesting that with more contact and time with the programme, there is greater impact. Lastly, m2m keeps women linked to health facilities, which is especially important after delivery as that has been an identified weakness of many PMTCT services.