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

项目摘要 产前护理为解决艾滋病毒污名化问题提供了一个独特而重要的切入点。基于耻辱 在第一次ANC访问期间进行咨询，可以促进那些 艾滋病毒感染者，可以解决艾滋病毒未感染者的污名化态度和行为。 有了这个应用程序，我们建议开发和试点测试一个简短的，可扩展的干预称为Maisha （斯瓦希里语终身），以解决坦桑尼亚向非洲人国民大会提出的妇女因艾滋病毒而蒙受耻辱的问题。干预将 包括：1）在ANC访问开始时（艾滋病毒感染前）播放视频和简短咨询， 检测），以及2）在视频的基础上，为感染艾滋病毒的妇女举办两次基于耻辱的咨询会议 内容提供情感支持，促进接受，解决耻辱，并加强护理参与。 主要的干预成果是感染艾滋病毒的妇女及早接受预防母婴传播护理。 我们还将审查所有妇女群体中艾滋病毒污名化的结果（已实施、预期、内化）， 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 内容是基于认知行为疗法的原则（解决自动消极的想法， 自我、未来和世界），以应对和减轻多种形式的艾滋病毒污名化（内化、预期 并颁布）。这项研究有三个目的：1）发展Maisha，以解决ANC期间的耻辱感，2）建立 在临床环境中评估Maisha的方法学方案，以及3）对Maisha进行试点测试， 确定在预防母婴传播护理环境中的可行性和可接受性，并探索对早期 PMTCT护理参与，艾滋病毒披露和耻辱。对于目标1和2，我们将使用多个定性 方法与各种利益相关者和临床观察，以及认知访谈，以完善我们的 污名化措施。对于目标3，我们将进行一项干预的试点RCT，招募所有参加 在莫希区的两个诊所进行了第一次ANC预约。麦莎将被比作艾滋病病毒的标准 不把重点放在耻辱上的咨询。除了基线评估外，所有被确定为 HIV感染者（n=25干预组，25对照组）和一组被确定为HIV未感染的妇女（n=50 干预组，50例对照组）将接受3个月评估。措施将包括健康成果（保健 参与，坚持，抑郁）和耻辱的结果，包括艾滋病毒的披露。质量保证数据 并描述干预和RCT的可行性和可接受性。统计 分析将检查健康结果和耻辱措施之间的差异，按 艾滋病毒感染状况。结果将用于生成参数估计值和估计值的潜在范围 未来R01提案的效力，这将是一项在PMTCT环境中进行的完全群集随机试验， 使用生物标志物进行随访和增强的依从性测量。

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.