Evaluation report
Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi—An Endline Evaluation
Kathryn L. Dovel, Pericles Kalande, Evelyn Udedi, Laurie Bruns, Chris Desmond et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated an integrated programme in Malawi that combined Early Childhood Development (ECD) counselling with HIV prevention and treatment services for mothers living with HIV and their infants. The programme delivered ECD guidance to mothers while they waited for their medical appointments, covering eight sessions over 12 months. Results showed high engagement with the programme and better health outcomes for both mothers and infants compared to standard services at other health facilities.
Key points
- 86% of mothers attended at least 5 of the 8 ECD counselling sessions over 12 months
- 88% of mothers in the integrated programme remained in HIV care at 12 months, compared to 59% in comparison facilities
- 96% of infants in the intervention received HIV testing by 6 weeks, compared to 66% in comparison facilities
- The programme was financially feasible to deliver within existing government health facility structures in Malawi
- High acceptability of combining ECD services with PMTCT programmes during routine clinical waiting times
Limitations
This was an observational study without randomisation, and the comparison facilities were not matched cohorts but rather routine facility-level data. The study does not establish causation or rule out confounding factors that may differ between intervention and comparison sites.
Abstract
We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers' retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Integrated Early Childhood Development (ECD) counselling using the WHO/UNICEF Care for Child Development package, delivered during PMTCT waiting times at health facilities, comprising up to 8 sessions over 12 months.
- Population
- 607 mother-infant pairs (average age 30 years and 7 weeks respectively) enrolled in PMTCT programs at 6 health facilities in Malawi between June 2018 and December 2019.
Key finding
88% of intervention mothers retained in PMTCT care at 12 months versus 59% in comparison facilities (29 percentage point difference)
Dovel et al. · Prof. Linda Richter (OpenAlex works) · 6 Feb 2023