A stigma reduction intervention at time of entry into antenatal care to improve PMTCT services in Tanzania

项目总结 产前护理(ANC)为解决艾滋病毒污名问题提供了一个独特而重要的切入点。基于柱头的 在第一次非国大访问期间进行咨询可以促进那些愿意开始和维持治疗的人 是艾滋病毒感染者，并可解决未感染艾滋病毒者的污名化态度和行为。 通过这一应用程序，我们计划开发和试点测试一种名为Maisha的简短、可扩展的干预 (斯瓦希里语终身)，以解决在坦桑尼亚向非国大提出报告的妇女对艾滋病毒的耻辱。这项干预将 包括：1)一段视频和简短的咨询，在非国大访问开始时(在艾滋病毒之前)解决艾滋病毒污名问题 测试)，以及2)在视频的基础上，为感染艾滋病毒的妇女提供两次基于污名的咨询会议 满足于提供情感支持，促进接受，解决污名，并加强关怀参与。 主要的干预结果是在感染艾滋病毒的妇女中及早参与预防母婴传播的护理。 我们还将检查所有妇女群体中艾滋病毒污名的后果(制定的、预期的、内化的)， 包括已经接受抗逆转录病毒治疗的妇女和未感染艾滋病毒的妇女。干预措施 内容基于认知-行为疗法的原则(解决关于 自我、未来和世界)，以应对和减轻多种形式的艾滋病毒污名(内化的、预期的 并制定)。这项研究有三个目标：1)发展Maisha以解决非国大期间的耻辱问题；2)建立 临床环境下评估Maisha的方法学方案，以及3)对Maisha TO进行中试 确定预防母婴传播护理环境的可行性和可接受性，并探索对早期预防母婴传播的影响 防止母婴传播关怀参与、艾滋病毒披露和耻辱。对于目标1和目标2，我们将使用多个定性 方法与不同的利益相关者和临床观察，以及认知访谈，以完善我们的 污名措施。对于目标3，我们将进行干预的RCT试点，招募所有参加 非国大首次在莫什区的两家诊所就诊。Maisha将与HIV的标准进行比较 没有关注污名的咨询。除了基线评估外，所有被确认为 艾滋病毒感染者(n=25名干预，25名对照)和一组被确认为未感染艾滋病毒的妇女(n=50 干预，50名对照)将得到3个月的评估。措施将包括健康结果(护理)。 参与、坚持、抑郁)和耻辱结果，包括艾滋病毒的披露。质量保证数据 将收集并描述干预和随机对照试验的可行性和可接受性。统计 分析将检查健康结果和污名测量条件之间的差异，按以下分层 艾滋病毒状况。结果将用于生成参数估计和要估计的值的潜在范围 为未来的R01提案提供动力，这将是预防母婴传播设置中的完全群集式随机试验，并扩展 使用生物标记物进行随访和增强依从性测量。

PROJECT SUMMARY Antenatal care (ANC) provides a unique and important entry point to address HIV stigma. Stigma-based counseling during the first ANC visit can promote readiness to initiate and sustain treatment among those who are HIV infected, and can address stigmatizing attitudes and behaviors among those who are HIV uninfected. With this application, we are proposing to develop and pilot test a brief, scalable intervention called Maisha (Swahili for life), to address HIV stigma for women presenting to ANC in Tanzania. The intervention will include: 1) a video and brief counseling that addresses HIV stigma at the start of the ANC visit (prior to HIV testing), and 2) two stigma-based counseling sessions for women who are HIV infected, building on the video content to provide emotional support, promote acceptance, address stigma, and reinforce care engagement. The primary intervention outcome is early engagement in PMTCT care among women who are HIV infected. We will also examine HIV stigma outcomes (enacted, anticipated, internalized) among all groups of women, including women who are already established on ART and women who are HIV uninfected. The intervention content is based on principles of cognitive-behavioral therapy (addressing automatic negative thoughts about the self, future and the world) to address and mitigate multiple forms of HIV stigma (internalized, anticipated and enacted). The study has three aims: 1) to develop Maisha to address stigma during ANC, 2) to establish the methodological protocol for the evaluation of Maisha in a clinical setting, and 3) to pilot test Maisha to determine feasibility and acceptability in a PMTCT care setting and explore potential for impact on early PMTCT care engagement, HIV disclosure, and stigma. For Aims 1 & 2, we will use multiple qualitative methods with a variety of stakeholders and clinical observations, as well as cognitive interviews to refine our stigma measures. For Aim 3, we will conduct a pilot RCT of the intervention, enrolling all women who attend a first ANC appointment at two clinics in the Moshi district. Maisha will be compared to the standard of HIV counseling without the focus on stigma. In addition to a baseline assessment, all women who are identified as HIV-infected (n=25 intervention, 25 control) and a subset of women who are identified as HIV-uninfected (n=50 intervention, 50 control) will get a 3-month assessment. Measures will include health outcomes (care engagement, adherence, depression) and stigma outcomes including HIV disclosure. Quality assurance data will be collected and the feasibility and acceptability of the intervention and RCT will be described. Statistical analysis will examine differences between conditions in health outcomes and stigma measures, stratified by HIV status. Results will be used to generate parameter estimates and potential ranges of values to estimate power for a future R01 proposal, which will be a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.