799 - Human-Centered Design of a Personalized Peer Support Strategy for Prevention of Vertical Transmission of HIV in Western Kenya

Publication Number: 799.5160

James Carlucci, Indiana University School of Medicine, Indianapolis, IN, United States; Rosa Chemwey, Kenyatta National Hospital, NAIROBI, Nairobi Area, Kenya; Bridget Hawryluk, Indiana University School of Medicine, Indianapolis, IN, United States; Marylydia A. Kiano, Academic Model Providing Access to Health Care, ELDORET, Rift Valley, Kenya; Violet Naanyu, Moi University, Eldoret, Rift Valley, Kenya; John Humphrey, Indiana University School of Medicine, Indianapolis, IN, United States; Alan McGuire, Richard L Roudebush VAMC, Indianapolis, IN, United States; Edwin Onyango. Were, Indiana University School of Medicine, Eldoret, Rift Valley, Kenya; Kara Wools-Kaloustian, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Mentor Mother (MM) services are an evidenced-based peer support strategy embedded within prevention of vertical transmission of HIV (PVT) programs. The current MM strategy in Kenya provides one-size-fits-all support focused on medication adherence and retention in care.

Objective: We aimed to develop an enhanced MM strategy capable of providing more personalized services to pregnant and postpartum women living with HIV (WLHIV) to more efficiently promote better clinical outcomes for mother-infant dyads.

Design/Methods: A participatory approach was used to gather and synthesize muti-level perspectives about current MM services and how to modify them within existing resource constraints to be more responsive to the individual needs of WLHIV. From May-November 2023, we conducted qualitative interviews with WLHIV (n=36) and MM (n=16) from three public health facilities supported by Academic Model Providing Access to Healthcare (AMPATH) in western Kenya to elicit key insights and inform subsequent human-centered design (HCD) workshops. The first two workshops included MM (n=9) and PVT clinicians (n=9), respectively. Hypothetical personas of low- and high-risk WLHIV were used for journey mapping. Affinity diagrams and rapid thematic analysis were then used to create a prototype enhanced MM strategy. A third workshop with PVT program leaders, AMPATH leadership, and county-level ministry of health representatives (n=6) was conducted to further refine the enhanced MM strategy. Analysis, synthesis, and model building were performed collaboratively with study team members from Kenya and Indiana.

Results: Core components of the enhanced MM strategy developed through HCD include: (i) iterative risk assessment of WLHIV at each clinical encounter, (ii) MM-administered counselling and services corresponding to WLHIV’s identified risk factors, and (iii) less intensive MM services for WLHIV without identified risk factors. In addition to promoting adherence and retention, protocols were created for MM to identify and address: HIV viremia, socioeconomic barriers, stigma, depression, and intimate partner violence. Building capacity for MM to provide these services was considered integral for successful implementation. Motivating MM and WLHIV through appreciation and material support were identified as key to promoting sustainability.

Conclusion(s): An enhanced MM strategy that provides differentiated services for mother-infant dyads affected by HIV was created through a HCD approach. Implementation and effectiveness of the enhanced MM strategy will be assessed in future studies.