Background: For nearly 15 years, mothers2mothers (m2m) has trained facility-based lay health workers in implementing a peer-to-peer “Mentor Mother” (MM) Model to support Prevention of Mother-to-Child Transmission (PMTCT) in sub-Saharan Africa. In 2015, m2m extracted a representative sample of their longitudinal client records to assess the relationship between exposure to facility-based MM visits, and key client health and behavioural outcomes along the PMTCT cascade.
Methods: A stratified random sampling approach was used to identify a representative sample of 87 out of 350 m2m supported facilities in Kenya, Lesotho, Uganda, South Africa, Swaziland and Malawi. A census of longitudinal clients records was taken for clients (n=12 976) first enrolled in mothers2mothers care between June and November 2012, and concluding care in December 2014. Exposure status of clients to the m2m model was defined retrospectively by dividing the sample into a low exposure group comprised of clients who had one MM visit after an outcome under investigation had occurred and a high exposure group who had two or more MM visits before an outcome under investigation had occurred. Multivariate regression was then used to explore group differences after adjusting for key confounders.
Results: Women with two or more MM visits were more likely to have an infant who was HIV-negative at the final test (AOR =6.4, p< 0.001). MM visit exposure status was also positively associated with key behavioural and PMTCT uptake indicators (see Table).

 Adjusted odds ratiosUnadjusted Frequencies
IndicatorAORp-value2+ m2m visits1 m2m visit
Maternal Behavioural OutcomesUsing Family Planning1.260.01274%65%
 Exclusive breast feeding first 6 months1.67<0.00184%75%
Uptake of Maternal PMTCT ServicesAntenatal Prophylaxis3.86<0.00196%77%
 Postnatal Prophylaxis2.27<0.00186%74%
Uptake of Infant PMTCT ServicesInfant prophylaxis1.600.01796%93%
 Infant CPT1.630.00178%72%
 6-8 week PCR test2.31<0.00175%52%
Impact - Mother-to-Child Transmission Rate at 18 MonthsInfant HIV status HIV-negative6.4<0.00193%70%
[Association between MM visit exposure and key behavioural and PMTCT uptake indicators]

Conclusions: Within a longitudinal cohort of clients receiving m2m support, exposure to more Mentor Mother visits appears to be positively associated with better client behavioural and PMTCT outcomes along the treatment cascade. The study builds a pervasive case for the efficacy of peer-to-peer support models delivered by a paid cadre of lay councillors at the facility level