EMMA: Enhanced mentor mother program

The EMMA study is the most recent activity in a multi-year collaboration between the Kenya Medical Research Institute (KEMRI), the Walter Reed Army Institute of Research (WRAIR), and the Henry Jackson Foundation for the Advancement of Military Medicine.

In Kenya all newly diagnosed HIV-infected pregnant women are immediately eligible for triple antiretroviral therapy (ART) for life since 2014. In addition, Kenya previously established the Kenya Mentor Mother Program (KMMP) in 2012 to improve peer education and psychosocial support services within the national prevention of mother-to-child transmission (PMTCT) program. The primary objectives of EMMA study, a cluster-randomized pragmatic evaluation, are: (1) to evaluate implementation of these new guidelines (ART for all with Mentor Mothers) as part of routine service delivery; and (2) to evaluate potential benefits of a package of services within the KMMP (called EMMA) to improve PMTCT service delivery. Enrollment in the study occurred during March 2017-June 2018.  Study follow up, from presenting for antenatal care through 28 weeks post-partum, is complete.  Data extraction from medical records, data entry and data analysis are on-going.  Final results are expected in late 2019.

The EMMA study protocol and previous papers from our multi-year collaboration with HJF, KEMRI, and WRAIR are listed below.

Boston University investigators Bruce Larson (PI), Nafisa Halim
Partner investigators HJF/WRAIR/KEMRI: Isaac Tshikutsu, Fredrick Sawe, Margaret Bii
Countries Kenya
Project period October 2015 – September 2019
Contacts Bruce Larson (Boston); Isaac Tshikutsu (Kericho, Kenya)

Publications and other documents

Larson BA, Bii M, Tsikhutsu I, Halim N, Wolfman V, Coakley P, et al. The Enhanced Mentor Mother ProgrAm ( EMMA ) for the prevention of mother-to- child transmission of HIV in Kenya : study protocol for a cluster randomized controlled trial. Trials. 2018;(19):594

Larson BA, Bii M, Halim N, Rohr JK, Sugut W, Sawe F. Incremental treatment costs for HIV-infected women initiating antiretroviral therapy during pregnancy: A 24-month micro-costing cohort study for a maternal and child health clinic in Kenya. PLoS One. 2018 Aug 10;13(8):e0200199.

Larson B, Tindikahwa A, Mwidu G, Kibuuka H, Magala F. How much does it cost to improve access to voluntary medical male circumcision among high-risk, low-income communities in Uganda? PLoS One. 2015;10(3):e0119484.

Larson, B. A., M. Bii, S. Henly-Thomas, K. McCoy, F. Sawe, D. Shaffer and S. Rosen (2013). ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics. Journal of the International AIDS Society 16: 18026.

Larson, B. A., M. P. Fox, M. Bii, S. Rosen, J. Rohr, D. Shaffer, F. Sawe, M. Wasunna and J. L. Simon (2013). Antiretroviral therapy, labor productivity, and sex: a longitudinal cohort study of tea pluckers in Kenya. AIDS 27(1): 115-123.

Fox, M. P., K. McCoy, B. A. Larson, S. Rosen, M. Bii, C. Sigei, D. Shaffer, F. Sawe, M. Wasunna and J. L. Simon (2010). Improvements in physical wellbeing over the first two years on antiretroviral therapy in western Kenya. AIDS Care 22(2): 137-145.

Larson, B. A., M. P. Fox, S. Rosen, M. Bii, C. Sigei, D. Shaffer, F. Sawe, K. McCoy, M. Wasunna and J. L. Simon (2009). Do the socioeconomic impacts of antiretroviral therapy vary by gender? A longitudinal study of Kenyan agricultural worker employment outcomes. BMC Public Health 9: 240.

Larson, B.A., Fox, M.P., Rosen, S., Bii, M., Sigei, C., Shaffer, D., Sawe, F., Wasunna, M., and J.L. Simon, Early effects of antiretroviral therapy on work performance: preliminary results from a cohort study of Kenyan agricultural workers, AIDS 22(2008): 421-425.