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

项目摘要/摘要 产程中的艾滋病毒污名会影响艾滋病毒携带者(WLHIV)和 影响妇女对艾滋病毒护理的长期承诺。尽管有证据表明分娩和分娩(L和D) 提供者可能向WLHIV提供次优和耻辱的护理，没有干预措施来解决HIV耻辱 在L&D供应商中。拟议的研究将通过开发模拟培训干预来填补这一空白 L&D供应商。该干预措施旨在通过建立临床 在WLHIV中管理常规分娩和产科急诊的技能和自我效能，以及应对态度 通过培养临床同理心和自我反省能力来消除耻辱。这项研究是基于一个概念性的 尊重、非污名化的产妇护理可以提高WLHIV对医疗系统和 将他们的承诺转变为长期参与艾滋病毒护理。在目标1中，我们将研究以下表现 在产期使用强有力的定性方法，包括深入访谈、焦点 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 Mama Mzazi，支持妇女生育健康项目)，通过修改证据-- 基于快速国际模拟培训课程，以改进循证管理 分娩和尊重产妇护理(RMC)。使用Adapt-ITT模型的迭代方法，我们将在 从目标1收集的本地背景问题和例子，以开发专门用于促进尊重、 WLHIV的非耻辱性出生。在AIM 3中，我们将在6点与L&D提供商一起试行妈妈干预 坦桑尼亚乞力马扎罗地区的诊所。与供应商(n=60)进行的前后调查将评估RMC 做法、工具性污名和污名化态度。与世界卫生组织WLHIV的调查和病历审查 在研究诊所分娩将在培训前和培训后进行比较(n=206)， 将RMC作为主要结果进行检查。普罗科特框架将指导可行性和可接受性衡量标准。 与我们的合作伙伴(乞力马扎罗基督教医疗中心)的能力建设活动将是 在整个赠款期间进行整合。在研究完成后，我们将有经验和数据来 通知多点随机对照试验，以检测对产后艾滋病毒护理参与度的影响。我们是 相信这项开发工作将显著提高更大规模试验的成功几率，以及 它解决了Fogarty制定高影响力干预措施以减轻艾滋病毒影响的优先事项 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.