Social networks and their role in early initiation of antenatal care by HIV serostatus in Uganda
Maternal and neonatal mortality and morbidity are persistently high in Uganda where there is also a generalized HIV epidemic. Ensuring early and appropriate antenatal care (ANC) allows for screening, treatment, and prevention of complications, while offering education and support to ensure healthy pregnancies and maternal and fetal outcomes. Few Ugandan women initiate antenatal care in the first trimester, as recommended. Timing of antenatal care initiation may vary by serostatus but there is little research on this. Social networks could play a critical role in facilitating early ANC initiation, yet evidence is limited. Understanding how social networks contribute to early ANC initiation, including differences by serostatus, is important for designing interventions that engage social networks to promote recommended ANC, including for pregnant women living with HIV. We seek to further develop the evidence-base on social networks and early ANC initiation, including differences by serostatus status, through a study proposed at Kawempe National Referral Hospital, in Kampala, Uganda. Our research aims are to assess the association between social network characteristics and early ANC initiation among pregnant women seeking ANC (Aim 1) and to compare social network structure and composition by serostatus and differences in association with early ANC initiation (Aim 2). We will achieve our aims by conducting a quantitative survey among 200 Ugandan women attending ANC, 50 of whom will be purposively selected for known HIV diagnosis. We will assess relationships and differences using linear and logistic regression analyses. This study will inform the development of a larger NIH R01 proposal investigating on a large scale the impact of social networks on early ANC initiation with comparisons by serostatus. Identifying how to engage social networks to support early ANC initiation will benefit the large number of pregnant women starting ANC late and ultimately improve health outcomes for them and their children.