GROW: Adapting and Enhancing Group-based Prenatal Care to Support Healthy Gestational Weight Gain for HIV-affected Women - ABSTRACT: Suboptimal gestational weight gain (GWG) is a modifiable risk factor for adverse pregnancy outcomes, postpartum weight retention and obesity, and subsequently, the long-term development of non-communicable diseases (NCD) among women and children. In South Africa, 45% of women exceed the Institute of Medicine’s (IOM) recommended weight gain in pregnancy, and 38% gain too little weight, putting them at risk for poor perinatal and postpartum NCD outcomes. Women in low- and middle-income countries (LMICs) with a high burden of HIV and NCDs, such as South Africa, are at particularly high risk of suboptimal weight gain due to poor diet quality, limited physical activity, high levels of psychosocial stressors, and, for women with HIV (WHIV), possible antiretroviral-associated weight gain. By supporting healthy GWG, there is strong potential to reduce postpartum NCD risk and improve perinatal outcomes for women with and without HIV. However, few GWG interventions are available for delivery in LMICs, and none have been adapted to address excessive and inadequate GWG or enhanced to meet the unique needs of women with and without HIV. To address this gap, our team previously developed an innovative, theoretically driven group prenatal care (GPNC) intervention and adapted it to reduce GWG and NCD (GPNC-NCD) risk in resource-constrained settings. GPNC-NCD is an evidence-based intervention, based on social cognitive theory, that builds health literacy, self-efficacy, social support, and satisfaction with care, leading to improved perinatal, GWG, NCD, and perinatal outcomes. The goal of this proposal is to adapt the GPNC-NCD intervention for use in South Africa to support healthy GWG (not too much or too little), enhance it to address the needs of WHIV and without HIV, and evaluate the feasibility, acceptability, and preliminary efficacy of the intervention to improve GWG, NCD, perinatal, and HIV care and prevention outcomes in a pilot randomized trial. Our specific aims are: 1) to adapt the GPNC-NCD intervention for use in South Africa to support healthy GWG and enhance it to address HIV status as a driver of GWG, and 2) to determine the feasibility, acceptability, and preliminary efficacy of the adapted and enhanced GPNC intervention. In a pilot trial, 80 women will be individually randomized by HIV status at ≤14 weeks gestation to GPNC (n=20 WHIV, n=20 HIV-) versus usual care (n=20 WHIV, n=20 HIV-). We hypothesize that adapted GPNC will be feasible, acceptable and show preliminary efficacy to improve GWG, NCD (blood pressure, breastfeeding, diet, physical activity), HIV care/prevention (ART adherence, viral suppression, or PreP uptake), and perinatal (birthweight, large-for-gestational age, cesarean delivery) outcomes. This proposal addresses the goals of PAR-23-191 by leveraging the evidence-based GPNC intervention to support healthy GWG, addresses HIV-NCD disparities, and builds capacity for HIV/NCD research in LMICs. If successful, our adapted GPNC intervention has strong potential to serve as a model for how to integrate NCD and HIV care and prevention support into routine prenatal care in LMICs to improve perinatal, HIV, and NCD outcomes.
