PMID- 22789640
OWN - NLM
STAT- MEDLINE
DCOM- 20121119
LR  - 20240418
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 15 Suppl 2
IP  - Suppl 2
DP  - 2012 Jul 11
TI  - Community-based approaches for prevention of mother to child transmission in 
      resource-poor settings: a social ecological review.
PG  - 17373
LID - 10.7448/IAS.15.4.17373 [doi]
LID - 17373 [doi]
AB  - INTRODUCTION: Numerous barriers to optimal uptake of prevention of mother to 
      child transmission (PMTCT) services occur at community level (i.e., outside the 
      healthcare setting). To achieve elimination of paediatric HIV, therefore, 
      interventions must also work within communities to address these barriers and 
      increase service use and need to be informed by evidence. This paper reviews 
      community-based approaches that have been used in resource-limited settings to 
      increase rates of PMTCT enrolment, retention in care and successful treatment 
      outcomes. It aims to identify which interventions work, why they may do so and 
      what knowledge gaps remain. METHODS: First, we identified barriers to PMTCT that 
      originate outside the health system. These were used to construct a social 
      ecological framework categorizing barriers to PMTCT into the following levels of 
      influence: individual, peer and family, community and sociocultural. We then used 
      this conceptual framework to guide a review of the literature on community-based 
      approaches, defined as interventions delivered outside of formal health settings, 
      with the goal of increasing uptake, retention, adherence and positive 
      psychosocial outcomes in PMTCT programmes in resource-poor countries. RESULTS: 
      Our review found evidence of effectiveness of strategies targeting individuals 
      and peer/family levels (e.g., providing household HIV testing and training peer 
      counsellors to support exclusive breastfeeding) and at community level (e.g., 
      participatory women's groups and home-based care to support adherence and 
      retention). Evidence is more limited for complex interventions combining multiple 
      strategies across different ecological levels. There is often little information 
      describing implementation; and approaches such as "community mobilization" remain 
      poorly defined. CONCLUSIONS: Evidence from existing community approaches can be 
      adapted for use in planning PMTCT. However, for successful replication of 
      evidence-based interventions to occur, comprehensive process evaluations are 
      needed to elucidate the pathways through which specific interventions achieve 
      desired PMTCT outcomes. A social ecological framework can help analyze the 
      complex interplay of facilitators and barriers to PMTCT service uptake in each 
      context, thus helping to inform selection of locally relevant community-based 
      interventions.
FAU - Busza, Joanna
AU  - Busza J
AD  - Department of Population Studies, London School of Hygiene & Tropical Medicine, 
      London, UK. Joanna.Busza@lshtm.ac.uk
FAU - Walker, Damilola
AU  - Walker D
FAU - Hairston, Alana
AU  - Hairston A
FAU - Gable, Alicia
AU  - Gable A
FAU - Pitter, Christian
AU  - Pitter C
FAU - Lee, Stephen
AU  - Lee S
FAU - Katirayi, Leila
AU  - Katirayi L
FAU - Simiyu, Rogers
AU  - Simiyu R
FAU - Mpofu, Daphne
AU  - Mpofu D
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Review
DEP - 20120711
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
SB  - IM
MH  - Communicable Disease Control/*methods
MH  - Community Networks
MH  - Female
MH  - HIV Infections/economics/*prevention & control/*transmission
MH  - Humans
MH  - Infectious Disease Transmission, Vertical/economics/*prevention & control
MH  - Male
MH  - *Social Support
PMC - PMC3499910
EDAT- 2012/07/14 06:00
MHDA- 2012/12/10 06:00
PMCR- 2012/07/11
CRDT- 2012/07/14 06:00
PHST- 2011/12/12 00:00 [received]
PHST- 2012/05/16 00:00 [accepted]
PHST- 2012/07/14 06:00 [entrez]
PHST- 2012/07/14 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
PHST- 2012/07/11 00:00 [pmc-release]
AID - 17373 [pii]
AID - 10.7448/IAS.15.4.17373 [doi]
PST - epublish
SO  - J Int AIDS Soc. 2012 Jul 11;15 Suppl 2(Suppl 2):17373. doi: 
      10.7448/IAS.15.4.17373.