“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Table 1 MoMent peer support program description, roles, and responsibilities

	Control arm mentor mother	Intervention arm mentor mother
Program description and requirements
HIV-positive woman	Yes	Yes
Experiential PMTCT knowledge	Yes	Yes
Standard pre-engagement selection criteria^a	No	Yes
Standard baseline training and curriculum with certification^b	No	Yes
Stipend for work activities	Yes (~ 50 USD monthly)	Yes (~ 50 USD monthly)
Schedule for client interaction^c	No	Yes
Scope of client-related work formally communicated^d	No	Yes
Facility or community-based activities	Both	Both
Linked to HIV+ clients at ANC clinic	Yes	Yes
Activity documentation	Weak, not standard, not consistently linked to PMTCT outcomes, often not reviewed	Emphasized, standard logbook provided, PMTCT outcomes-specific, reviewed by MM supervisor
Supportive supervision	Weak support and supervision, responsibility of facility staff-in-charge	Emphasized, responsibility of supportive MM supervisor who reports to staff-in-charge
Audits of client interaction activities^e	No	Yes
Formal performance evaluations	No	Yes, based on client feedback
Re-orientation or disengagement based on performance	No	Yes
Peer support activities
Document client interactions	Yes, inconsistent (in non-standardized notebooks)	Yes, required (in standardized, outcomes-specific logbook)
Conduct HIV tests for ANC clinic clients	No	No
Immediately flag clients with missed appointments	No	Yes
Track clients with missed appointments	Yes, after several weeks	Yes, required within 3 days
Daily feedback sessions with supervisor	No	Yes

PMTCT prevention of mother-to-child transmission of HIV, USD US dollars, ANC antenatal care, MM mentor mother
^aHIV-positive, 18–45 years old, successfully completed PMTCT program at least once; speaks ≥ 1 local language; disclosed to partner/family member; willing to disclose HIV status to peers
^b5-day, 17-module training including pre- and post-test and counseling role-play
^cHome visit within 5 days of client assignment, twice monthly visits, visit within 3 or 7 days if non-facility or facility delivery, respectively
^dVia written contract provided and explained to all MMs in English or other language they understood
^eOne randomly selected client interviewed every 6 months to validate MM reports on interactions with client and for client feedback on MM performance

ISSN: 1478-4491