‘Mothers moving towards empowerment’ intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial

Trials

Patlo Entaile¹  Haitisha Mehta²  Evan Eschliman²  Timothy D. Becker³  Ohemaa B. Poku⁴  Melody Goodman⁵  Supriya Misra⁵  Lawrence H. Yang⁶  Tonya Arscott-Mills⁷  Ari R. Ho-Foster⁷  Shathani Rampa⁸  Philip Renison Opondo⁸  Tadele Melese⁸  Bruce Link⁹  Valerie Jackson^1,10  Vivian Go^1,11  Michael B. Blank^1,12  Marlene Eisenberg^1,12 

[1] Botswana-UPenn Partnership, Gaborone, Botswana;Columbia University, New York, NY, United States;Icahn School of Medicine at Mount Sinai, New York, NY, United States;Johns Hopkins University, Baltimore, MD, United States;New York University, New York, NY, United States;New York University, New York, NY, United States;Columbia University Mailman School of Public Health, New York, NY, USA;Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States;University of Botswana, Gaborone, Botswana;University of Botswana, Gaborone, Botswana;University of California Riverside, Riverside, CA, USA;University of California San Francisco, San Francisco, CA, United States;University of North Carolina at Chapel Hill, Chapel Hil, NC, USA;University of Pennsylvania, Philadelphia, PA, United States;

关键词: HIV/AIDS;    Intervention;    Culture;    Botswana;    Postpartum;    Stigma;    ART;   

DOI  :  10.1186/s13063-020-04676-6

来源: Springer

【 摘 要 】

BackgroundWith high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children’s lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the “What Matters Most” stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the “Mothers Moving towards Empowerment” (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period.MethodsThis study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status).DiscussionOur trial will evaluate MME, a culturally based HIV stigma reduction intervention using the “What Matters Most” framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana.Trial registrationClinicalTrials.gov NCT03698981. Registered on October 8, 2018

【 授权许可】

CC BY