A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania

项目总结/摘要 分娩期间的艾滋病毒污名化会影响艾滋病毒感染妇女的生育结果， 影响妇女对艾滋病毒护理长期承诺。尽管有证据表明，劳动和分娩（L&D） 提供者可能为WLHIV提供次优和污名化的护理，没有干预措施来解决艾滋病毒污名化问题 在L&D供应商中。拟议的研究将填补这一空白，开发一个模拟训练干预， L&D供应商该干预措施旨在通过建立临床 技能和自我效能，以管理WLHIV中的常规分娩和产科急诊，并解决 通过培养临床同情和自我反思的能力，消除污名化。这项研究是建立在一个概念 尊重，非污名化的孕产妇护理可以提高WLHIV对医疗系统的信任， 将他们的承诺转变为长期参与艾滋病毒护理。在AIM 1中，我们将检查 使用强有力的定性方法，包括深入访谈，重点 小组讨论、分娩观察和设施评估。在AIM 2中，我们将开发MAMA（Mradi wa Afya ya Mama Mzazi，支持生育妇女健康项目）， 基于PRONTO国际课程的模拟培训，以提高循证管理 生育和尊重产妇护理。使用ADAPT-ITT模型的迭代方法，我们将建立在 从目标1中收集的当地背景问题和例子， 对WLHIV的非污名化分娩。在AIM 3中，我们将在六个月内与L&D提供商进行MAMA干预的试点测试。 坦桑尼亚基利曼哈罗地区的诊所。与供应商（n=60）进行的前后调查将评估RMC 歧视性做法、工具性污名化和污名化态度。调查和医疗记录审查与WLHIV谁 将比较培训前和培训后期间在研究诊所分娩的情况（n=206）， 将RMC作为主要结果进行检查。普罗克特框架将指导可行性和可接受性指标。 与我们的合作伙伴（基利曼哈罗基督教医疗中心）的能力建设活动将 在整个补助期内，待研究完成后，我们便会有经验和数据， 为多中心随机对照试验提供信息，以检测对产后艾滋病毒护理参与的影响。我们 相信这项开发工作将大大提高更大规模试验成功的可能性， 它解决了福格蒂的优先事项，以制定高影响力的干预措施，以减轻艾滋病毒的影响 耻辱

PROJECT SUMMARY / ABSTRACT HIV stigma during the intrapartum period can impact birth outcomes for women living with HIV (WLHIV) and influence women’s long-term commitment to HIV care. Despite evidence that labor and delivery (L&D) providers may deliver suboptimal and stigmatizing care to WLHIV, no interventions exist to address HIV stigma among L&D providers. The proposed study will fill this gap by developing a simulation training intervention for L&D providers. The intervention is designed to address providers’ instrumental stigma by building the clinical skills and self-efficacy to manage routine births and obstetric emergencies in WLHIV, and address attitudinal stigma by building capacity for clinical empathy and self-reflection. The study is grounded in a conceptual model that respectful, non-stigmatizing maternity care can improve WLHIV’s trust in the medical system and in turn their commitment to long-term engagement in HIV care. In AIM 1, we will examine the manifestations of HIV stigma during the intrapartum period using robust qualitative methods, including in-depth interviews, focus group discussions, observations of childbirth, and facility assessments. In AIM 2, we will develop MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth) by adapting the evidence- based PRONTO International curriculum of simulation training to improve evidence-based management of birth and respectful maternity care (RMC). Using iterative methods of the ADAPT-ITT model, we will build on local contextual issues and examples gleaned from Aim 1 to develop content specific to promoting respectful, non-stigmatizing birth for WLHIV. In AIM 3, we will pilot test the MAMA intervention with L&D providers at six clinics in the Kilimanjaro Region of Tanzania. Pre- and post-surveys with providers (n=60) will assess RMC practices, instrumental stigma and stigmatizing attitudes. Surveys and medical record review with WLHIV who give birth in the study clinics will be compared in the pre-training and the post-training periods (n=206), examining RMC as a primary outcome. The Proctor framework will guide feasibility and acceptability metrics. Capacity building activities with our collaborating partner (Kilimanjaro Christian Medical Center) will be integrated throughout the grant period. Upon completion of the study, we will have the experience and data to inform a multi-site RCT that is powered to detect impacts on postpartum HIV care engagement. We are confident that this developmental work will significantly enhance the probability of success of a larger trial, and that it addresses the priorities of Fogarty to develop high-impact interventions to mitigate the impact of HIV stigma.