"I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone": Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi
"I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone": Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi
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DOI：
10.1371/journal.pone.0217693
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发表时间：
2019-06-07
期刊：
影响因子：
3.7
通讯作者：
Herce, Michael E.
中科院分区：
文献类型：
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作者：
Carbone, Nicole B.;Njala, Joseph;Herce, Michael E.
背景与成年女性相比，撒哈拉以南非洲地区感染艾滋病毒的怀孕和产后少女和年轻女性 (AGYW) 在预防艾滋病毒母婴传播 (PMTCT) 级联方面的效果较差。然而，尽管结果存在这种不平等，但该地区描述 AGYW 观点的数据却很少，无法为青少年敏感的 PMTCT 规划提供信息。在本文中，我们报告了形成性实施研究的结果，该研究考察了马拉维感染 HIV 的 AGYW 的 PMTCT 护理的障碍和促进因素，并探讨了调整母亲对母亲 (m2m) 导师母亲模式的策略，以更好地满足 AGYW 服务提供相关的需求和偏好。方法定性研究人员在马拉维 4 个感染 HIV 的青少年母亲地区进行了 16 次焦点小组讨论 (FGD) 15-19 岁分为两组：1) 有 m2m 编程经验的人（8 FGD，n = 38）； 2) 没有这样做的人（8 次 FGD，n = 34）。使用主题分析对 FGD 数据进行分析，以评估主要和次要主题并比较各组之间的结果。结果参与者年龄中位数为 17 岁（四分位数间距：2 岁）。贫困、耻辱、粮食不安全、缺乏交通和缺乏社会心理支持是参与预防母婴传播的交叉障碍。虽然大多数参与者强调韧性和自我效能是继续护理以保护自己和孩子健康的激励因素，但他们也表示希望获得量身定制、适合年龄的服务。 FGD 参与者表示更喜欢由感染艾滋病毒的青少年导师母亲提供的支持服务，这些母亲本身已经成功地完成了 PMTCT 级联。 结论 感染艾滋病毒的青少年母亲表示更喜欢同伴主导的、非评判性的 PMTCT 支持服务，这些服务能够在社区和设施之间架起桥梁，务实地解决耻辱、贫困、卫生系统复杂性和粮食不安全等障碍。未来的研究应该评估以这些和其他以客户为中心的属性的青少年导师母亲服务的实施和健康结果，例如提供生计援助和同伴主导的社会心理支持。
BackgroundPregnant and post-partum adolescent girls and young women (AGYW) living with HIV in sub-Saharan Africa experience inferior outcomes along the prevention of mother-to-child transmission of HIV (PMTCT) cascade compared to their adult counterparts. Yet, despite this inequality in outcomes, scarce data from the region describe AGYW perspectives to inform adolescent-sensitive PMTCT programming. In this paper, we report findings from formative implementation research examining barriers to, and facilitators of, PMTCT care for HIV-infected AGYW in Malawi, and explore strategies for adapting the mothers2mothers (m2m) Mentor Mother Model to better meet AGYW service delivery-related needs and preferences.MethodsQualitative researchers conducted 16 focus group discussions (FGDs) in 4 Malawi districts with HIV-infected adolescent mothers ages 15-19 years categorized into two groups: 1) those who had experience with m2m programming (8 FGDs, n = 38); and 2) those who did not (8 FGDs, n = 34). FGD data were analyzed using thematic analysis to assess major and minor themes and to compare findings between groups.ResultsMedian participant age was 17 years (interquartile range: 2 years). Poverty, stigma, food insecurity, lack of transport, and absence of psychosocial support were crosscutting barriers to PMTCT engagement. While most participants highlighted resilience and self-efficacy as motivating factors to remain in care to protect their own health and that of their children, they also indicated a desire for tailored, age-appropriate services. FGD participants indicated preference for support services delivered by adolescent HIV-infected mentor mothers who have successfully navigated the PMTCT cascade themselves.ConclusionsHIV-infected adolescent mothers expressed a preference for peer-led, non-judgmental PMTCT support services that bridge communities and facilities to pragmatically address barriers of stigma, poverty, health system complexity, and food insecurity. Future research should evaluate implementation and health outcomes for adolescent mentor mother services featuring these and other client-centered attributes, such as provision of livelihood assistance and peer-led psychosocial support.