Effect of a Congregation-Based Intervention on Uptake of HIV Testing and Linkage to Care in Pregnant Women in Nigeria (Baby Shower): A Cluster Randomised Trial (Ezeanolue, 2015)
Ezeanolue, Echezona E., Michael C. Obiefune, Chinenye O. Ezeanolue et al., “Effect of a Congregation-Based Intervention on Uptake of HIV Testing and Linkage to Care in Pregnant Women in Nigeria (Baby Shower): A Cluster Randomised Trial,” The Lancet Global Health 3, no.11 (November 2015), doi:10.1016/S2214-109X(15)00195-3
URL: www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00195-3/fulltext
Abstract
Background: Few effective community-based interventions exist to increase HIV testing and uptake of antiretroviral therapy (ART) in pregnant women in hard-to-reach resource-limited settings. We assessed whether delivery of an intervention through churches, the Healthy Beginning Initiative, would increase uptake of HIV testing in pregnant women compared with standard health facility referral.
Methods: In this cluster randomised trial, we enrolled self-identified pregnant women aged 18 years and older who attended churches in southeast Nigeria. We randomised churches (clusters) to intervention or control groups, stratified by mean annual number of infant baptisms (<80 vs ≥80). The Healthy Beginning Initiative intervention included health education and on-site laboratory testing implemented during baby showers in intervention group churches, whereas participants in control group churches were referred to health facilities as standard. Participants and investigators were aware of church allocation. The primary outcome was confirmed HIV testing. This trial is registered with ClinicalTrials.gov, identifier number NCT 01795261.
Findings: Between Jan 20, 2013, and Aug 31, 2014, we enrolled 3002 participants at 40 churches (20 per group). 1309 (79%) of 1647 women attended antenatal care in the intervention group compared with 1080 (80%) of 1355 in the control group. 1514 women (92%) in the intervention group had an HIV test compared with 740 (55%) controls (adjusted odds ratio 11·2, 95% CI 8·77–14·25; p<0·0001).
Interpretation: Culturally adapted, community-based programmes such as the Healthy Beginning Initiative can be effective in increasing HIV screening in pregnant women in resource-limited settings.
Funding: US National Institutes of Health and US President’s Emergency Plan for AIDS Relief.
This study demonstrates the positive impact of a “country-owned approach,” relying on faith-based communities for pregnant women needing to be tested and treated for HIV. Faith-based communities and organizations often play a key role in women and children receiving the quality care they need. This is particularly effective in a country like Nigeria, which is ranked highly in church attendance.
