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mothers2mothers (m2m) is a peer support program that trains and employs HIV-positive mothers to conduct support groups, provide counseling, and educate pregnant women about prevention of mother-to-child transmission of HIV, and provides lunches and nutrition education.1
We reviewed an independent evaluation of the mothers2mothers program.2 The evaluation measured a number of factors,3 but we focus on evidence measuring the direct change in behavior: receipt and ingestion of the antiretroviral drug Nevirapine consistent with our take on what constitutes measurement of impact.
The evaluation focused on three health facilities in which mothers2mothers programs were located.4 Clinic providers identified women who might meet the eligibility criteria for the evaluation5 and selected both women who had engaged with mothers2mothers and those that did not.6 The study found a significant difference in the percentage of participants (93%) who had received and taken the drug vs. the percentage of non-participants (83%) who had received and taken the drug.7
However, like many studies evaluating charities' activities, this study appears to suffer from selection bias. There is no reason to believe that the women who participated in mothers2mothers programming are similar (in the ways that matter to drug uptake) to those who did not, and strong reason to believe that they may differ systematically. In particular, it seems highly likely to us that women who chose to participate in mothers2mothers are the same women who would be more likely to receive and take the appropriate drugs.
We therefore do not find this evaluation to be strong evidence regarding mothers2mothers' impact among pregnant women with HIV.
mothers2mothers, "How We Work."
The factors were:
Baek 2007, Pg 8.
"There were three evaluation sites in the Pietermaritzburg area of KwaZulu-Natal. These sites drew women from urban and peri-urban settings." Baek 2007, Pg 1.
"Women were eligible for the study if they were between the ages of 18 and 49 years (inclusive) and they knew their HIV status. To participate in the study, pregnant women had to be between 6 and 9 months gestation. For new mothers, the eligibility criteria were slightly different at baseline (1–12 weeks postpartum) than at follow up (4–12 weeks postpartum). Clinic providers identified women who might qualify for the evaluation, briefly introduced the study to them, and referred them to the interviewers, who provided more information about the study." Baek 2007, Pg 8.
"The study examined how PMTCT knowledge and behaviors, and uptake of services changed over time (baseline to follow-up) and differed based on whether or not women participated in m2m activities. The m2m program considered a minimum of two contacts between a mentor mother and an antenatal or postpartum client to be programmatically meaningful; therefore, study respondents were considered program participants if they spoke with a mentor mother two or more times. The definition of a contact was broad; a contact could occur either before or after delivery, and could involve participation in a one-on-one interaction or a group session." Baek 2007, Pg 10.
Baek 2007, Pg 18.