Outcomes of home visits for pregnant mothers and their infants: a cluster randomized controlled trial

le Roux, Ingrid M.a; Tomlinson, Markb; Harwood, Jessica M.c; O’Connor, Mary J.d; Worthman, Carol M.e; Mbewu, Nokwanelea; Stewart, Jacquelinef; Hartley, Maryf; Swendeman, Dallasg; Comulada, W. Scottg; Weiss, Robert E.h; Rotheram-Borus, Mary Janei

doi: 10.1097/QAD.0b013e3283601b53
Epidemiology and Social

Objective: To evaluate the effect of home visits by community health workers (CHWs) on maternal and infant well being from pregnancy through the first 6 months of life for women living with HIV (WLH) and all neighborhood mothers.

Design and methods: In a cluster randomized controlled trial in Cape Town townships, neighborhoods were randomized within matched pairs to either standard care, comprehensive healthcare at clinics (n = 12 neighborhoods; n = 169 WLH; n = 594 total mothers); or Philani Intervention Program, home visits by CHWs in addition to standard care (PIP; n = 12 neighborhoods; n = 185 WLH; n = 644 total mothers). Participants were assessed during pregnancy (2% refusal) and reassessed at 1 week (92%) and 6 months (88%) postbirth. We analyzed PIP's effect on 28 measures of maternal and infant well being among WLH and among all mothers using random effects regression models. For each group, PIP's overall effectiveness was evaluated using a binomial test for correlated outcomes.

Results: Significant overall benefits were found in PIP compared to standard care among WLH and among all participants. Secondarily, compared to standard care, PIP WLH were more likely to complete tasks to prevent vertical transmission, use one feeding method for 6 months, avoid birth-related medical complications, and have infants with healthy height-for-age measurements. Among all mothers, compared to standard care, PIP mothers were more likely to use condoms consistently, breastfeed exclusively for 6 months, and have infants with healthy height-for-age measurements.

Conclusion: PIP is a model for countries facing significant reductions in HIV funding whose families face multiple health risks.

aPhilani Maternal, Child Health and Nutrition Project, Cape Town

bDepartment of Psychology, Stellenbosch University, Matieland, South Africa

cCenter for Community Health, University of California, Los Angeles

dDepartment of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

eEmory University, Atlanta, Georgia, USA

fStellenbosch University, Matieland, South Africa

gPsychiatry & Biobehavioral Sciences, University of California, Los Angeles

hDepartment of Biostatistics, Fielding School of Public Health

iGlobal Center for Children and Families, University of California, Los Angeles, Los Angeles, California, USA.

Correspondence to Mary Jane Rotheram-Borus, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA. E-mail: rotheram@ucla.edu/CCHPublications@mednet.ucla.edu

Received 26 October, 2012

Revised 29 January, 2013

Accepted 12 February, 2013

© 2013 Lippincott Williams & Wilkins, Inc.