Financial Diaries to Understand the Economic Context of PMTCT Retention and Adherence in Zomba, Malawi

Malawi piloted the innovative Option B+ approach, which allows HIV-positive pregnant and breastfeeding women to immediately begin taking ART and continue for life, regardless of CD4 count. Although Option B+ has contributed to significant improvements in enrolling women into prevention of mother-to-child transmission (PMTCT) care, loss to follow up continues to pose a significant challenge. The various barriers to PMTCT retention are well-documented, with many barriers linked to socio-economic vulnerability. However, economic strengthening (ES) interventions, which can address the economic determinants of poor health in many contexts, have not been the focus of strategies to improve retention and adherence for PMTCT. As such, Dr. Lorenzetti is leading the design and implementation of a study using the financial diaries methodology, which collects weekly data for seven months on the financial in-flows and out-flows of HIV-positive pregnant women and new mothers. This descriptive study will provide a holistic and contextualized understanding of the financial lives of women in PMTCT in Zomba, Malawi, including an assessment of financial behaviors linked to PMTCT retention, ART adherence, and food security. This study will ultimately yield recommendations on ES programming that supports women in seeking and remaining in PMTCT services.

The Role of Community Savings Groups in Supporting ART Adherence and Retention in HIV Care in Beira and Chimoio, Mozambique

Mozambique has one of the highest adult HIV prevalence rates in the world, with more than 1.5 million people living with HIV. As UNAIDS has rolled out the “test and start” approach, linked to their Fast-Track Strategy to end the HIV epidemic by 2030, the number of people initiated on ART in Mozambique has increased. However, only 66% of ART clients are retained after 12 months. There is growing evidence that economic strengthening (ES) interventions complement clinical HIV services by addressing critical barriers to care and supporting achievement of positive health outcomes. Savings groups (SGs) are a widely used ES intervention that have shown some promise, having positive effects on outcomes linked to retention and adherence. However, there is limited understanding of the extent to which SGs affect retention and adherence or the mechanisms through which they achieve improvements in these outcomes. Dr. Lorenzetti is designing and implementing a study with SG members in Mozambique to examine the potential pathways through which SGs influence retention in care and adherence to ART. The long-term goal is to identify the aspects of SG membership that bolster adherence and retention and to better tailor these interventions to meet the unique needs of PLHIV.

Qualitative Tracer Study of Caregivers Graduated from an OVC Program in Four Counties in Kenya’s Northern Arid Lands

Orphans and Vulnerable Children (OVC) programs identify vulnerable households and provide economic and social support services to ensure that children are stable, safe, healthy, and schooled. Households graduate from these programs once they have met minimum criteria for well-being outcomes known as graduation benchmarks. Despite the growth of OVC programs, there is limited guidance on how resources should be provided and sequenced to prevent households from backsliding, or returning to a state of pre-graduation vulnerability. To better understand the types and sequencing of services that promote sustainability, Dr. Lorenzetti has helped design a qualitative study with graduated caregivers from an OVC program in the Northern Arid Lands of Kenya. This study will augment the findings of a tracer study, which assesses the vulnerability status of graduated caregivers, by conducting in-depth interviews with caregivers who have sustained outcomes and those who have backslid. The study will also include key informant interviews with program implementers.

Gender in Biomedical HIV Prevention Trials

Since the early 2000s, biomedical HIV prevention trials have embraced approaches emphasizing community engagement and social protection. Despite the importance of gender dynamics in influencing decisions to participate, use products, and be retained in a trial, gender considerations are not explicitly addressed in such trials. Furthermore, given past controversies regarding biomedical trials with vulnerable populations, including female sex workers, there are arguments to adopt procedures that promote gender transformative practices. Dr. Lorenzetti conducted a systematic review of articles from 2001-2017 to analyze gender-related issues affecting key populations in biomedical HIV prevention trials and generate recommendations to make such trials gender transformative.

Girls’ Math Identity in STEM

Dr. Lorenzetti is working with a team of educational equity experts to conduct a systematic literature review that examines the relationship between girls’ math identity (i.e. their beliefs and dispositions toward math) and their academic achievement in science, technology, engineering, and math (STEM). Dr. Lorenzetti is providing methodological support for this review, which seeks to address one particular challenge that contributes to the persistent under-representation of women in STEM education and careers. A copy of the systematic review protocol can be found here.