‘What is needed is confidentiality’: Peer supporters’ experiences supporting PMTCT adolescent girls and young mothers in Kasungu District, Malawi

Background: Despite notable achievements in the prevention of mother‒child transmission of HIV (PMTCT) services, high dropout rates among adolescent girls and young mothers (AGYM) aged 13–24 years have been noted. To improve service uptake, the use of peer support for AGYMs in PMTCT settings was proposed. Although qualitative studies have been conducted on the use of peer support in PMTCT in sub-Saharan Africa, little is known about the experiences of peer supporters. We conducted qualitative research with AGYMs who were trained to provide peer support to gain an understanding of their experiencesinteracting with their peers as part of a pilot study that aimed to assess whether peer support among AGYMs could be integrated into PMTCT care settings. Methods: This was a descriptive, qualitative study. The data sources included nine in-depth interviews with purposively selected peer supporters, a review of peer supporters’ recording forms, and training evaluation forms. These data were then analyzed. Findings: Analysis of the data yielded four main themes: the perceived role of peer supporters, the motivating aspect of peer support, the enablers of peer support, and the challenges of peer support. We found that peer supporters may enhance service uptake by providing emotional and psychosocial support and linking mothers to care. We also identified key considerations when designing a comprehensive peer support program, including the provision of peer training, reinforcing the maintenance of professionalism by peer supporters, and providing support and mentorship to peer supporters. The study further revealed the need for the inclusion of family support in peer support programs to mitigate prevailing peer support challenges. Conclusion: Peer support for AGYMs in PMTCT settings may be implementable; however, a broad range of contextual factors must be considered.