3 research outputs found
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âMothers moving towards empowermentâ intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial
Background
With 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 childrenâs 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 âWhat Matters Mostâ 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 âMothers Moving towards Empowermentâ (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.
Methods
This 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 16Â 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 <â16âweeks), birth weight, vaccination record, and HIV status).
Discussion
Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the âWhat Matters Mostâ 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 registration
ClinicalTrials.gov NCT03698981
. Registered on October 8, 201
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A pilot pragmatic trial of a âwhat matters mostâ-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana
We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving ârespected motherhoodâ (âwhat matters mostâ) in Botswana. A pragmatic design allocated participants to the intervention (Nâ=â44) group and the treatment-as-usual (Nâ=â15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (dâ=ââ 1.20; 95% CI â 1.99, â 0.39) and depressive symptoms (dâ=ââ 1.96; 95% CI â 2.89, â 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma