A Qualitative Evaluation of the Mentor Mother Program for HIV-Positive Pregnant and Lactating Women in Gaza Province, Mozambique

Overview

In response to challenges with HIV-positive pregnant and breastfeeding women remaining in care and treatment, the Mentor Mother Program (MMP) was launched in 2016. The program is modeled after South Africa’s Mother to Mother (M2M) program, where HIV-positive women provide support and mentoring to other HIV-positive pregnant women by visiting them in their homes and attending facility appointments with them. The following evaluation was conducted to understand the acceptability and feasibility of the program in Mozambique from both the patient and provider perspectives. In-depth interviews and focus group discussions (FGDs) were conducted with HIV-positive women receiving care in the MMP, HIV-positive women who declined to receive care in the MMP, mentor mothers (MMs) supporting the HIV-positive women, health care workers (HCWs), mentor mother supervisors, MM program managers, MM program coordinators and MM program focal points.

The study results identified many program successes. Respondents indicated that MMs provided key information related to HIV and treatment that women were lacking. Mentor Mothers helped women to accept their HIV status and supported disclosure efforts. In general, HIV-positive women reported feeling less alone, less isolated and more in control of their health after enrolling in the MMP. Health care workers reported strongly valuing the support the MMs provided, especially in terms of their success at supporting defaulters in reintegration into care at the facility level.

One of the main challenges was insufficient information about the content of home visits provided to both HIV-positive women in general and those enrolled in the MMs Program. The HIV-positive women said that they often did not know what to expect from the MMs in terms of initial approaches. In addition, the MMs wanted to receive more guidance from supervisors about what is expected during the first visits. Another main challenge, which has since been resolved, was MMs arriving in uniforms on bicycles and with folders that made them easily identifiable as coming from a health facility and being recognized as linked to an HIV program. Shortly after this challenge was registered in the early stages of program implementation, all identifiable MM items were removed to keep confidentiality and avoid misinterpretation from community members. The MMs reported many other challenges performing their job, such as insufficient stipends and resources, distances that were too far to cover, and too many patients to see. The COVID-19 pandemic created the additional challenge of not being able to visit homes, which resulted in even more strains on financial resources to get airtime for phone calls to women.

Participants made recommendations to strengthen MM training and support, improve communication to the HIV-positive women, create a stronger link with the community and increase the number of MMs trained and working.

The MMP fills a much-needed gap of helping to improve HIV-positive women’s understanding of antiretroviral therapy (ART) and the importance of returning to the health facility for treatment follow-up. The program also helps MMs and HIV-positive women have a sense of community. There are many opportunities to strengthen and improve this program. The creation and implementation of this program in Mozambique has been a step in the right direction, but more work is needed for this program to reach its full potential.