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Kays M, Woelk G, Callahan T, et al. Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi. PLoS One. 2021;16(8):e0255788doi: 10.1371/journal.pone.0255788.
Kays, M., Woelk, G., Callahan, T., Katirayi, L., Montandon, M., Chauwa, F., Laterra, A., Sampathkumar, V., Kayira, D., Kalua, T., Kazemi, E., Hoffman, H., & Modi, S. (2021). Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi. PloS one, 16(8), e0255788. https://doi.org/10.1371/journal.pone.0255788
Kays, Megan, et al. "Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi." PloS one vol. 16,8 (2021): e0255788. doi: https://doi.org/10.1371/journal.pone.0255788
Kays M, Woelk G, Callahan T, Katirayi L, Montandon M, Chauwa F, Laterra A, Sampathkumar V, Kayira D, Kalua T, Kazemi E, Hoffman H, Modi S. Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi. PLoS One. 2021 Aug 11;16(8):e0255788. doi: 10.1371/journal.pone.0255788. eCollection 2021. PMID: 34379657; PMCID: PMC8357126.
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PLoS One. 2021 Aug 11;16(8):e0255788. doi: 10.1371/journal.pone.0255788. eCollection 2021.

Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.

PloS one

Megan Kays, Godfrey Woelk, Tegan Callahan, Leila Katirayi, Michele Montandon, Felluna Chauwa, Anne Laterra, Veena Sampathkumar, Dumbani Kayira, Thokozani Kalua, Erin Kazemi, Heather Hoffman, Surbhi Modi

Affiliations

  1. Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
  2. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  3. Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
  4. Cooperative for Assistance and Relief Everywhere, Inc., Atlanta, Georgia, United States of America.
  5. Centers for Disease Control and Prevention, Lilongwe, Malawi.
  6. Malawi Ministry of Health, Lilongwe, Malawi.
  7. Department of Biostatistics and Bioinformatics, Milken Institute of School Public Health, The George Washington University, Washington, DC, United States of America.

PMID: 34379657 PMCID: PMC8357126 DOI: 10.1371/journal.pone.0255788

Abstract

Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE's) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.

Conflict of interest statement

The authors declare that they have no competing interests.

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