Community-based programming
HIV testing, care, and treatment
Prevention of mother-to-child transmission
University of North Carolina
Partners in Health
Malawi Ministry of Health
Five districts from Northern, Central and Southern Malawi (Mzimba South, Dedza, Lilongwe, Neno and Zomba)
Michael Herce, The University of North Carolina at Chapel Hill (UNC)
Joseph Njala, UNC
Innocent Mofolo, UNC

Evaluating Community-facility Linkage Models to Promote Mother-infant Retention Along the HIV Care Continuum in Malawi

©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.