Double benefit? Integrating an early childhood development programme into HIV PMTCT Option B plus services in Malawi

We investigated the feasibility and acceptability of integrating early childhood development into Prevention of Mother-to-Child Transmission (PMTCT) services in Malawi. We recruited mothers living with HIV in the PMTCT programs who had an infant <= 8 weeks of age. Group ECD sessions were delivered while mothers waited for HIV consultations. Follow up was conducted at 9 months postnatal. A sub-sample of mothers completed in-depth interviews which were translated, transcribed, and analyzed. 197 mothers were recruited for the integrated program: 147/197 (75%) enrolled, 114/147 (78%) completed follow up, and 62/114 (54%) completed interviews. Acceptability of the program was high, with reports of improved self-confidence and parenting capacity, increased father involvement and improved relationships with healthcare providers. Participants reported that the program made PMTCT visits more enjoyable and supportive, and reduced time and effort required for HIV care. Mothers also believed stigma within healthcare settings was reduced. The integration of ECD into PMTCT is feasible and acceptable in a low-resource setting like Malawi. Findings indicate that the integration has potential to increase satisfaction and potential retention in HIV care programs. Additional research is required to test the effects of integrated programs on child health and development, maternal health and adherence. Key messages Benefits for mothers and children can be achieved through the successful integration of an early childhood development programme into PMTCT Option B+ services in Malawi. Our study based on in-depth interviews with 62 mothers indicated that such an approach is feasible and acceptable. Participating mothers reported that the integration of the early childhood development component improved their confidence and they believed it improved their parenting; led to improved relationships with health care providers; increased the engagement of fathers and support from others in the family; helped mothers build a new social network and support system through the peer engagement components; reduced the risk of stigmatization in the health care setting.