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Preventing HIV/AIDS by Building Capacity to Reduce Stigma Among Providers for Pregnant Women in Rural Haiti.

通过能力建设减少海地农村地区孕妇服务提供者的耻辱来预防艾滋病毒/艾滋病。

基本信息

批准号：
10067398
负责人：
Jasmine Abrams
金额：
$ 13.15万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10067398
关键词：
Preventing HIV AIDS Building Capacity

项目摘要

PROJECT SUMMARY Sabotaging the possibility of an AIDS free generation, stigma continues to undermine primary and secondary prevention efforts in Haiti. Given Haitian women's increased vulnerability for HIV, the possibility of perinatal transmission, and the likelihood of increased contact with healthcare providers during pregnancy, this proposal aims to develop and pilot a culturally relevant multilevel intervention targeted at lessening the influence of stigma in undermining important preventative and treatment seeking behaviors among pregnant Haitian women. The intervention will train providers in healthcare settings and traditional birth attendants (i.e., matrones) in community settings to abate stigmatizing attitudes and behaviors so as to eliminate the negative impact of stigma before it begins. Further, as stigma is a barrier to linking HIV positive pregnant women to care, the secondary goal of this proposal is to enhance the capacity of providers and matrones to introduce and retain women in the HIV care continuum, which includes enhanced linkages to and retention in care. Moving beyond individual level approaches, we will employ a community based participatory research approach to work collaboratively with community based organizations to develop a multi-level stigma reduction intervention based on the Global Stigma Reduction Framework, an adaptable model used to inform development of stigma reduction programming. The intervention will have two components: (1) a healthcare system intervention for providers (i.e., doctors, nurses, and midwives) serving pregnant women and (2) a community-level intervention for matrones. We will develop this intervention through formative research with pregnant women, matrones, community leaders, and maternal health and HIV prevention/treatment clinicians. This research will allow us to gather information about experiences with and drivers of stigma in the community and healthcare system. Using results of the formative research, the intervention will be developed by a working leadership group consisting of HIV prevention experts, healthcare providers, and community members. To obtain information about intervention acceptability, feasibility, satisfaction, and preliminary evidence of improved outcomes, we will conduct a pilot quasi-experimental trial of providers at four healthcare facilities and matrones in the surrounding communities (randomizing 2 clinics/communities to the intervention group and 2 to the control group). Additionally, we will assess the indirect impact of the intervention by conducting serial cross-sectional assessments with pregnant women under the care of providers/matrones in the control and intervention groups. By addressing stigmatizing attitudes and associated behavior in healthcare and community settings, we aim to create an environment that will foster greater utilization of HIV preventive and treatment services in order to reduce HIV risk for pregnant women, their unborn children, and their partners. This innovative research is needed and has potential to provide a model for addressing stigma in other low and middle-income countries (LMICs) to address stigma as a barrier to HIV prevention and treatment.

项目总结破坏无艾滋病一代的可能性，耻辱继续破坏主要和次要的海地的预防工作。鉴于海地妇女感染艾滋病毒的脆弱性增加，围产期感染艾滋病毒的可能性传播，以及在怀孕期间与医疗保健提供者接触增加的可能性，这项提议旨在开发和试点具有文化相关性的多层次干预措施，旨在减少海地孕妇的耻辱破坏了重要的预防和治疗行为女人。该干预将在医疗保健环境中培训提供者和传统的助产士(即，在社区环境中)，以减少污名化的态度和行为，从而消除负面耻辱的影响在它开始之前。此外，由于耻辱是将艾滋病毒阳性孕妇与护理，这项提议的次要目标是加强提供者和护士长的能力，以引入并将妇女保留在艾滋病毒护理连续体中，其中包括加强与护理的联系和保留护理。超越个人层面的方法，我们将采用基于社区的参与性研究与以社区为基础的组织合作的方法，以制定多层次的减少污名基于全球减少耻辱框架的干预，这是一种可适应的模式，用于制定减少污名方案。干预措施将包括两个组成部分：(1)医疗保健为孕妇提供服务的提供者(即医生、护士和助产士)的系统干预和(2) 对护士长的社区干预。我们将通过形成性研究来发展这种干预孕妇、护士长、社区领袖、产妇保健和艾滋病毒预防/治疗临床医生。这项研究将使我们能够收集关于社区中耻辱的经历和驱动因素的信息和医疗保健系统。利用形成性研究的结果，将由工作人员开发干预由艾滋病毒预防专家、医疗保健提供者和社区成员组成的领导小组。至获取有关干预措施的可接受性、可行性、满意度和初步证据的信息为了改善结果，我们将在四个医疗机构和周围社区的护士长(将2个诊所/社区随机分配到干预组，2个随机分配到对照组)。此外，我们将通过进行一系列的干预来评估干预的间接影响在对照和护理服务提供者/主妇的照顾下对孕妇进行横断面评估干预组。通过解决医疗保健领域的污名化态度和相关行为在社区环境中，我们的目标是创造一种环境，促进更多地利用艾滋病毒预防和提供治疗服务，以降低孕妇、其未出生的孩子及其伴侣感染艾滋病毒的风险。这一创新研究是必要的，并有可能为解决其他低收入和低收入人群的耻辱问题提供一个模式中等收入国家解决污名问题，将其作为艾滋病毒预防和治疗的障碍。