Browsing by Author "Stein, Alan"

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    A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants
    (PLoS, 2014-01-22) Rotheram-Borus, Mary Jane; Richter, Linda M.; Van Heerden, Alastair; Van Rooyen, Heidi; Tomlinson, Mark; Harwood, Jessica M.; Comulada, W. Scott; Stein, Alan
    Objective: We evaluate the effect of clinic-based support by HIV-positive Peer Mentors, in addition to standard clinic care, on maternal and infant well-being among Women Living with HIV (WLH) from pregnancy through the infant's first year of life. Methods: In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for pregnant WLH to receive either: a Standard Care condition (SC; 4 clinics; n = 656 WLH); or an Enhanced Intervention (EI; 4 clinics; n = 544 WLH). WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors, in addition to SC. WLH were recruited during pregnancy, and at least two post-birth assessment interviews were completed by 57% of WLH at 1.5, 6 or 12 months. EI's effect was ascertained on 19 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall efficacy. Findings: WLH attended an average of 4.1 sessions (SD = 2.0); 13% did not attend any sessions. Significant overall benefits were found in EI compared to SC using the binomial test. Secondarily, over time, WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition. EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months. Conclusions: WLH benefit by support from HIV-positive Peer Mentors, even though EI participation was partial, with incomplete follow-up rates from 6–12 months.
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    Project Masihambisane : a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV
    (BioMed Central, 2011-01) Rotheram-Borus, Mary-Jane; Richter, Linda; Van Rooyen, Heidi; Van Heerden, Alastair; Tomlinson, Mark; Stein, Alan; Rochat, Tamsen; De Kadt, Julia; Mtungwa, Nonhle; Mkhize, Lungile; Ndlovu, Lindo; Ntombela, Lungile; Comulada, W. Scott; Desmond, Katherine A.; Greco, Erin
    Background: Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. Methods/Design: As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Discussion: Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. Trial registration: ClinicalTrials.gov registration # NCT00972699