{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:18:21Z","timestamp":1783567101363,"version":"3.55.0"},"reference-count":101,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2012,7,11]],"date-time":"2012-07-11T00:00:00Z","timestamp":1341964800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community\u2010based approaches that have been used in resource\u2010limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community\u2010based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource\u2010poor countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our review found evidence of effectiveness of strategies targeting individuals and peer\/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home\u2010based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as \u201ccommunity mobilization\u201d remain poorly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence\u2010based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community\u2010based interventions.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.15.4.17373","type":"journal-article","created":{"date-parts":[[2012,7,12]],"date-time":"2012-07-12T08:23:22Z","timestamp":1342081402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Community\u2010based approaches for prevention of mother to child transmission in resource\u2010poor settings: a social ecological review"],"prefix":"10.1002","volume":"15","author":[{"given":"Joanna","family":"Busza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damilola","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"Hairston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Gable","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Pitter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Katirayi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogers","family":"Simiyu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Mpofu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,7,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60877-5"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-2-10"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","unstructured":"ThompsonMA MugaveroMJ AmicoKR CargillVA ChangLW GrossR et al.Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence\u2010based recommendations from an International Association of Physicians in AIDS Care Panel.Ann Intern Med.2012:E\u2013419.","DOI":"10.7326\/0003-4819-156-11-201206050-00419"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-9-59"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.10.94"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq048"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.05.034"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001056"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040298"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02005.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02733.x"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545109708315326"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200212153-00010"},{"issue":"4","key":"e_1_2_12_15_1","first-page":"476","article-title":"Patterns of individual and population\u2010level adherence to antiretroviral therapy and risk factors for poor adherence in the first year of the DART trial in Uganda and Zimbabwe","volume":"48","author":"Muyingo SK","year":"2008","journal-title":"[Miscellaneous Article]. J Acquir Immune Defic Syndr"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-8-401"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-354"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31821ec6e2"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2011.00029.x"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32834b005d"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200412150-00016"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200301030-00009"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2010.01699.x"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000179425.27036.d7"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120802707467"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2008.0201"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.4314\/eamj.v85i4.9639"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000011"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000248349.25630.3d"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-551"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8709.2009.00201.x"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02091.x"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2008.0164"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02510.x"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.2217\/17469600.1.3.331"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.03.042"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2006.20.649"},{"issue":"1","key":"e_1_2_12_38_1","first-page":"427","article-title":"Driving the devil away","volume":"10","author":"Roura M","journal-title":"qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32823ecf7f"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.04.019448"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-5-15"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/0890334409341050"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-14-21"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-7-12"},{"issue":"9650","key":"e_1_2_12_45_1","first-page":"1684","volume":"372","author":"Blas E","year":"2008","journal-title":"Addressing social determinants of health inequities: what can the state and civil society do? Lancet"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60563-2"},{"key":"e_1_2_12_47_1","volume-title":"Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health","author":"CSDH","year":"2008"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxh006"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.01.003"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/30.4.668"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077801298004003002"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2004.10.015"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120500121185"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.09.012"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2008.0129"},{"issue":"1","key":"e_1_2_12_56_1","first-page":"1","article-title":"An exploration of contextual factors that influence HIV risk in female sex workers in Mexico: the social ecological model applied to HIV risk behaviors","volume":"21","author":"Larios SE","year":"2009","journal-title":"AIDS Care"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1258\/1355819054308576"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.063719"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1086\/425282"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2011.03.004"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2006.09.027"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/28.1.10"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.082602"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-13-S2-S2"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181e9e069"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70060-3"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0016488"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.03.006"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328348fb85"},{"key":"e_1_2_12_70_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-14-43"},{"key":"e_1_2_12_71_1","doi-asserted-by":"crossref","DOI":"10.31899\/HIV2.1023","volume-title":"Key findings from an evaluation of the mothers2mothers program in KwaZulu\u2010Natal, South Africa HORIZONS Final Report","author":"Baek C","year":"2007"},{"key":"e_1_2_12_72_1","doi-asserted-by":"publisher","DOI":"10.1177\/0890334410369481"},{"key":"e_1_2_12_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03159-7"},{"key":"e_1_2_12_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60738-1"},{"key":"e_1_2_12_75_1","doi-asserted-by":"publisher","DOI":"10.1086\/421408"},{"key":"e_1_2_12_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2011.02.011"},{"key":"e_1_2_12_77_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32834380c1"},{"key":"e_1_2_12_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61674-3"},{"key":"e_1_2_12_79_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czq005"},{"key":"e_1_2_12_80_1","volume-title":"Global experience of community health workers for delivery of health related millenium development goals: a systematic reivew, country case studies and recommendations","author":"Bhutta ZA","year":"2010"},{"key":"e_1_2_12_81_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000366082.68321.d6"},{"issue":"10","key":"e_1_2_12_82_1","first-page":"2096","volume":"66","author":"Standing H","year":"2008","journal-title":"Producing effective knowledge agents in a pluralistic environment: what future for community health workers? Soc Sci Med"},{"issue":"3","key":"e_1_2_12_83_1","first-page":"CD004015","article-title":"Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases","author":"Lewin S","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_84_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0002204"},{"key":"e_1_2_12_85_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010923"},{"key":"e_1_2_12_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmwh.2006.12.018"},{"key":"e_1_2_12_87_1","volume-title":"Scaling the frontier: traditional birth attendant involvement in PMTCT service delivery in Hai and Kilombero districts of Tanzania. Abstract no","author":"Msaky H","year":"2004"},{"key":"e_1_2_12_88_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-7-31"},{"key":"e_1_2_12_89_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120903483042"},{"key":"e_1_2_12_90_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.3.400"},{"key":"e_1_2_12_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(97)00208-6"},{"key":"e_1_2_12_92_1","first-page":"S27","article-title":"Empowerment, community mobilization and social change in the face of HIV\/AIDS","volume":"10","author":"Parker RG","year":"1996","journal-title":"AIDS"},{"key":"e_1_2_12_93_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31818a6cb5"},{"key":"e_1_2_12_94_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2009.0307"},{"key":"e_1_2_12_95_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-698X-10-25"},{"key":"e_1_2_12_96_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17021-9"},{"key":"e_1_2_12_97_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)62042-0"},{"key":"e_1_2_12_98_1","first-page":"S65","volume":"107","author":"Lee AC","year":"2009","journal-title":"Linking families and facilities for care at birth: what works to avert intrapartum\u2010related deaths? Int J Gynecol Obstet"},{"key":"e_1_2_12_99_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-11-88"},{"key":"e_1_2_12_100_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120903112351"},{"key":"e_1_2_12_101_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.16.1900"},{"key":"e_1_2_12_102_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-97"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.7448\/IAS.15.4.17373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T08:59:12Z","timestamp":1695805152000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.7448\/IAS.15.4.17373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7]]},"references-count":101,"journal-issue":{"issue":"S2","published-print":{"date-parts":[[2012,7]]}},"alternative-id":["10.7448\/IAS.15.4.17373"],"URL":"https:\/\/doi.org\/10.7448\/ias.15.4.17373","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,7]]},"assertion":[{"value":"2011-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-05-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-07-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"17373"}}