: UNAIDS has set a goal of achieving the elimination of
mother-to-child transmission (eMTCT) of HIV by 2015 and keeping
HIV-positive (HIV+) mothers alive. In pursuit of this goal, in 2011,
the Malawi Ministry of Health (MoH) adopted the Option B+ strategy,
which entails lifelong antiretroviral treatment for all HIV+
mothers, irrespective of severity of HIV infection. Poor mother–child
pair retention is one of the major challenges against achieving this
goal. To improve retention of mother–infant pairs in the eMTCT
continuum of care, the Promoting Retention among Infants and
Mothers Effectively (PRIME) study is evaluating the effectiveness
of 3 models of health care delivery namely, mother–infant pair
clinics, which deliver integrated HIV and non-HIV services,
mother–infant pair clinics plus electronic text message (SMS)
reminders for mother–infant pairs who miss scheduled eMTCT
follow-up clinics, and current standard of care. The primary outcome
is “the proportion of HIV+ mothers and/or HIV-exposed
infants (HEI) retained in eMTCT care at 12 months postpartum
and received recommended HIV and non-HIV services during preceding
scheduled visits.” This 3-arm cluster randomized intervention
study is being implemented in 30 primary health facilities
(10 facilities per arm) in Mangochi and Salima districts, Malawi.
At each clinic, a total of 41 HIV+ mothers attending maternal and
child health services are being recruited and followed up for
18 months postpartum. This article describes the study methodology
and interventions, successes and challenges experienced during the
first 12 months of study implementation and relevance of study results
to Malawi and other countries adopting the Option B+ strategy.