A Peer-Mother Counseling Intervention Improves Early Infant HIV Testing in Rural Uganda

Peer-led counseling interventions could improve early infant diagnosis of HIV by empowering mothers with knowledge and information on their role in preventing perinatal transmission. We hypothesized that a peer-led intervention would increase completion rates of infant HIV testing in rural Uganda.

From September 2019 to October 2021, we conducted the Enhanced viral load counseling with Standardized Peer-Support (ENHANCED-SPS) trial, which randomized 14 public health facilities to the intervention: peer-led counseling on HIV viral load and perinatal transmission, support for status disclosure and treatment adherence, and point-of-care viral load testing; or control: HIV care per national guidelines (NCT04122144). We retrospectively reviewed medical records of all infants born to ENHANCED-SPS participants during the 1-year follow-up and compared the proportions completing final testing (antibody rapid test at 18 months) between arms with targeted minimum loss-based estimation. Secondary outcomes included completion of earlier steps in the testing algorithm for the HIV-exposed infants.

Among 464 children (intervention = 234 and control = 230) born to trial participants, the proportions completing final testing were 94.5% (95% CI: 91.6-97.5%) in the intervention and 83.3% (95% CI: 78.4-88.3%) in the control: a difference of 11.2% (CI: 5.4-17.0%; P < 0.001). There were no differences in the proportions completing the 1st test (at 4-6 weeks) or the 2nd test (at 9 months), but completion of the 3rd test (6 weeks after breastfeeding cessation) was 14.8% (95% CI: 7.9-21.8%; P < 0.001) higher in the intervention.

Peer-led counseling on the mother's role in ensuring a healthy baby reduced drop-offs in infant HIV testing, which is progress toward improved infant diagnosis and prompt linkage to care.