# Group Antenatal Care: Effectiveness for Maternal/Infant and HIV Prevention Outcomes and Contextual Factors Linked to Implementation Success in Malawi

> **NIH NIH R01** · UNIVERSITY OF ILLINOIS AT CHICAGO · 2021 · $621,826

## Abstract

Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for 2/3 of
new HIV infections and 1/4 of preterm births. Antenatal (prenatal) care is the entry point into the health system
for many women and offers a unique opportunity to provide life-saving monitoring. However, provider
shortages, low quality of care and failure to attend all recommended visits mean that the potential benefits of
antenatal care are not realized. There is an urgent need to test novel interventions to reduce health risks for
mother and child. Group antenatal care is a transformative model of care that provides a positive pregnancy
experience, uses provider time efficiently, and improves perinatal and HIV-related outcomes. Women in group
antenatal care have 2-hour visits with the same provider in a group of 8-12 women at a similar stage of
pregnancy. Women conduct self-assessments, briefly consult the midwife, and meet for 80-90 minutes of
interactive health promotion enlivened by games and role-plays. Women form relationships with midwives and
each other. In a US randomized clinical trial (RCT), group care improved prematurity rates, antenatal care
attendance, satisfaction with care, breastfeeding practices, safer sex behaviors, and uptake of family planning.
Our randomized pilot in Malawi and Tanzania had promising outcomes. More women in group care than in
usual care completed ≥4 antenatal visits (94% vs 58%). Their partners were more likely to be tested for HIV
during pregnancy (51% vs. 27%). We established that group antenatal care can be offered in a rigorous RCT
with high fidelity despite provider shortages. The next step is an adequately powered effectiveness trial.
Malawi is an especially appropriate site because it has the world's highest prematurity rate (18%) and high HIV
prevalence (10% nationally, 16% at the study site). We use a hybrid design to simultaneously conduct an
effectiveness RCT with individual-level randomization and examine implementation processes at 6 clinics in
Blantyre District, Malawi. Aim 1 is to evaluate the effectiveness of group antenatal care through 6 months
postpartum. We hypothesize that compared to usual care, women in group care and their infants will have less
morbidity and mortality and more positive HIV prevention outcomes. We test Aim 1 hypotheses using multi-
level hierarchical models using data from repeated surveys and health records. Aim 2 is to identify clinic-level
degree of implementation success and contextual factors associated with success for each clinic and across
clinics. Analyses use within and across-case matrices. This high-impact study addresses three global health
priorities, maternal and infant mortality and HIV prevention, that affect all women of childbearing age in Malawi.
The Ministry of Health strongly supports this project; results will help them decide whether to scale-up this
innovative model of group care. Negative results will avoid spending on ineffective c...

## Key facts

- **NIH application ID:** 10163271
- **Project number:** 5R01NR018115-04
- **Recipient organization:** UNIVERSITY OF ILLINOIS AT CHICAGO
- **Principal Investigator:** Crystal Lauren Patil
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $621,826
- **Award type:** 5
- **Project period:** 2018-08-22 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10163271

## Citation

> US National Institutes of Health, RePORTER application 10163271, Group Antenatal Care: Effectiveness for Maternal/Infant and HIV Prevention Outcomes and Contextual Factors Linked to Implementation Success in Malawi (5R01NR018115-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10163271. Licensed CC0.

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