©Neil James Spicer

 
The issue
Despite the impressive maternal and child health gains achieved by the Option B+ and test and start strategies in Malawi, client attrition along the prevention of mother-to-child (PMTCT) care continuum threatens recent progress. Several service delivery models have emerged to increase PMTCT care retention for HIV-positive mothers and their infants by strengthening connections between health facilities and their surrounding communities.

Our approach
This study is rigorously characterizing three such models of “community-facility linkage,” and comparing their impact against each other and the standard of care according to routinely collected health outcomes for mother-infant pairs, including 12-month maternal retention in care and viral suppression, and 12-month infant HIV-free survival. Specific objectives are to:

1. Establish a clear typology for community-facility linkage models by describing the main components of, and key stakeholder perspectives on, three such models in Malawi;
2. Describe mother-infant pair health outcomes in each model, and compare outcomes across models and versus the standard of care;
   1. Determine individual-level outcomes for a retrospective cohort comprised of all mothers who newly enrolled in the national PMTCT program in 2016 across 40 randomly selected health facilities and their surrounding communities in 5 representative districts of Malawi; and
   2. Prospectively ascertain mother-infant pair vital status, maternal viral load, and infant HIV status from a randomly selected nested sample of 1,600 mother-infant pairs from the 2016 cohort.

 
The impact
The study will identify components of community-based mother-infant pair support that are associated with maternal care retention and infant HIV-free survival to refine and accelerate scale up of promising community-facility linkage practices in Malawi and sub-Saharan Africa and further accelerate Malawi’s progress toward achieving ambitious 90-90-90 targets.