Project Summary/Abstract
Stigma is a significant barrier to HIV prevention and treatment
. Stigma
is associated with psychosocial
challenges, including lack of social support and depression. Sub-Saharan Africa (SSA) has the highest rate of
HIV infection among childbearing women. Young women (< 24 years) are twice as likely to be HIV-positive
than men of the same age. In SSA, women living with HIV (WLWH) also experience pervasive stigma related
to both HIV infection and being pregnant in the context of HIV infection, with HIV-related stigma associated
with poor adherence to antiretroviral medication, postpartum depression, loss to follow-up, and low utilization of
healthcare services to prevent mother-to-child transmission. Despite the impact of unique stigma experiences
during pregnancy and postpartum, targeted interventions to reduce HIV stigma are lacking in SSA. In fact,
WLWH in Ghana have among the highest levels of HIV-related stigma and depression with no intervention
available to address these health outcomes. We propose to adapt and test an intervention module from Project
Accept’s (HPTN 043, U01MH066701) Post Test Support Services (PTSS) that reduced HIV-related stigma and
improved outcomes for adults in the USA and reduced community-level stigma when adapted to adults living in
Tanzania, Zimbabwe, South Africa and Thailand. Given HIV treatment lapses in postpartum WLWH in Ghana
and throughout SSA, targeted stigma interventions for this population represent a critical unmet need, with
implications for WLWH and stigma interventions globally. To address this need, we propose to adapt the PTSS
module for pregnant and postpartum WLWH with the ultimate goal of reducing stigma and depression and
increasing engagement in HIV treatment in this high-risk population, leading to better maternal-child outcomes.
In Aim 1, longitudinal data from 30 WLWH will be used to describe their stigma experience during pregnancy
and postpartum and effects on mental health (depression, anxiety) to inform the Project Accept intervention
adaptation process and compare with in-depth interview data from care providers (n=20) on their perspectives
of stigma, providing care in the context of stigma, and intervention needs. In Aim 2, we will form a community
advisory board to adapt the PTSS module using the ADAPT-ITT model with particular focus on cultural and
gender. We will solicit both healthcare providers’ and patient-level feedback about the pilot intervention prior to
implementing Aim 3. In Aim 3, we will evaluate feasibility, acceptability, and potential efficacy (on stigma,
mental health and ART adherence) of the adapted intervention during a pilot test with 90 WLWH randomized
and stratified by developmental age group to either intervention or usual care controls, guided by the NIH
Stage Model for behavioral intervention development. These findings will provide foundational data on
feasibility and acceptability to refine the design, sampling, and measures for a large multi-country randomized
controlled trial to rigorously test the impact of a peer-based, culturally and gender-tailored intervention adapted
for pregnant and postpartum WLWH to reduce HIV-related stigma and barriers to HIV treatment.
