Perspectives on enhancing peer support services for mothers living with HIV in Kenya: A qualitative assessment of Mentor Mothers and the mothers they serve

Mentor Mother (MM) services are an evidenced-based peer support strategy embedded within prevention of mother-to-child transmission of HIV (PMTCT) programs. The current MM strategy in Kenya provides monthly, facility-based, one-size-fits-all antiretroviral therapy adherence counselling and health education to women living with HIV (WLHIV) who are navigating PMTCT services. MMs receive a small monthly stipend as compensation for providing these services. We aimed to gather formative information from MMs and their client WLHIV, with the goal of developing an enhanced MM strategy that accounts for the unique needs of each WLHIV. From April-July 2023, we conducted qualitative interviews with MMs (n = 16) and WLHIV (n = 36) from three public health facilities supported by Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Interviews and analysis were guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Key findings included that both MMs and client WLHIV had favorable opinions about the possibility of developing and implementing a risk-stratified MM strategy wherein client WLHIV with identifiable risk factors receive intensified, problem-focused services while low-risk WLHIV are eligible for less intensive services. MMs and client WLHIV also agreed that empathetic MM-client relationships that leverage shared lived experiences to build trust and address stigma should remain central to the MM program. However, MMs were clear that a better-defined scope of work and capacity building through training and skills development would be necessary for successful implementation of an enhanced MM strategy. Additionally, motivating MMs with fair compensation and recognition for their work, as well as providing more resources for client WLHIV with economic barriers to care, could promote adoption and sustainability of an enhanced MM strategy. Additional participatory research, as well as input from system-level stakeholders, is needed to ensure feasible enhancements to MM services are contextualized within the real-world constraints of PMTCT programs.