Background: Poor retention of mothers and HIV-exposed infants
(HEIs) in HIV care threatens efforts to eliminate pediatric HIV.
Novel strategies are required to address this challenge. We compared
12-month maternal and HEI postpartum retention in health facilities
implementing the following HIV care delivery models: integrated
HIV and maternal, neonatal, and child health services [mother–infant
pair (MIP) clinics], MIP clinics plus short-text messaging service
(SMS) reminders to prevent default (MIP + SMS), and standard of
care (SOC).
Methods: From May 2013 to August 2016, a cluster randomized
trial was conducted in rural Malawi, which randomized 30 health
facilities to the 3 service delivery models. HIV+ pregnant women
and HEIs were enrolled and followed up to monitor compliance with
prescheduled visits and retention. Log binomial regression, using
generalized estimated equation, was used to assess the impact of the
models on retention.
Results: The trial enrolled 461, 493, and 396 HIV+ pregnant
women and 386, 399, and 300 HEIs into the MIP, MIP + SMS, and
SOC arms, respectively. Compared with the 12-month maternal
retention rate in the SOC arm (22.2%), the rates were similar in the
MIP arm [19.3%, risk ratio (RR): 0.85, 95% confidence interval (CI):
0.56 to 1.30] and in the MIP + SMS arm (24.9%, RR: 1.08, 95% CI:
0.87 to 1.35). Compared with the 12-month infant retention rate in
the SOC arm (9.8%), the rates were similar in the MIP arm (8.0%,
RR: 0.89, 95% CI: 0.31 to 2.58) and in the MIP + SMS arm (19.5%,
RR: 1.40, 95% CI: 0.85 to 2.31).
Conclusions: MIP and MIP + SMS service delivery models were
ineffective in improving maternal and infant retention in rural Malawi.