A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): Study protocol for a pilot randomized controlled trial

Abstract Background: HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counselling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. Methods : A pilot randomized control trial (RCT) will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A sub-set of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. Discussion : Antenatal care (ANC) provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.

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A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): Study protocol for a pilot randomized controlled trial

10.21203/rs.2.13793/v1 ◽

2019 ◽

Author(s):

Melissa H. Watt ◽

Elizabeth T. Knippler ◽

Linda Minja ◽

Godfrey Kisigo ◽

Brandon A. Knettel ◽

...

Keyword(s):

Antenatal Care ◽

Health Outcomes ◽

Hiv Testing ◽

Hiv Stigma ◽

Hiv Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Counseling Intervention ◽

Hiv Care Engagement

Abstract Background: HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counselling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. Methods : A pilot randomized control trial (RCT) will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A sub-set of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. Discussion : Antenatal care (ANC) provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.

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A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): study protocol for a pilot randomized controlled trial

Trials ◽

10.1186/s13063-019-3933-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Melissa H. Watt ◽

Elizabeth T. Knippler ◽

Linda Minja ◽

Godfrey Kisigo ◽

Brandon A. Knettel ◽

...

Keyword(s):

Antenatal Care ◽

Health Outcomes ◽

Hiv Testing ◽

Hiv Stigma ◽

Hiv Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Counseling Intervention ◽

Hiv Care Engagement

Abstract Background HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counseling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. Methods A pilot randomized control trial will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). A total of 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A subset of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. Discussion ANC provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot trial will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker. Trial registration ClinicalTrials.gov, NCT03600142. Registered on 25 July 2018.

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HIV Community-Level Stigmatizing Attitudes in Tanzania: Perspectives from Antenatal Care

East African Health Research Journal ◽

10.24248/eahrj.v4i2.635 ◽

2020 ◽

Vol 4 (2) ◽

pp. 118-127

Author(s):

Saumya Sao ◽

Brandon A Knettel ◽

Godfrey A Kisigo ◽

Elizabeth T Knippler ◽

Haika Osaki ◽

...

Keyword(s):

Antenatal Care ◽

Role Models ◽

Healthcare Workers ◽

Family Members ◽

Community Level ◽

Hiv Stigma ◽

Hiv Care ◽

People Living With Hiv ◽

Stigmatizing Attitudes ◽

Living With Hiv

Introduction: Stigma significantly impacts retention in HIV care and quality of life among people living with HIV. This study explored community-level HIV stigma from the perspective of patients and healthcare workers in antenatal care (ANC) in Moshi, Tanzania. Methods: We conducted in-depth interviews with 32 women (20 living with HIV), key-informant interviews with 7 ANC clinic employees, and two focus group discussions with 13 community health workers. Results: Themes emerged related to drivers and manifestations of stigma, resilience to stigmatizing attitudes, and opportunities to address stigma in ANC. Drivers of stigma included a fear of infection through social contact and associations of HIV with physical weakness (e.g., death, sickness) and immoral behaviour (e.g., sexual promiscuity). Manifestations included gossip, physical and social isolation, and changes in intimate relationships. At the same time, participants identified people who were resilient to stigmatizing attitudes, most notably individuals who worked in healthcare, family members with relevant life experiences, and some supportive male partners. Conclusion/Recommendations: Supportive family members, partners, and healthcare workers can serve as role models for stigma-resilient behaviour through communication platforms and peer programs in ANC. Manifestations of HIV stigma show clear links to constructs of sexuality, gender, and masculinity, which may be particularly impactful during pregnancy care. The persistence of stigma emphasizes the need for innovation in addressing stigmatizing attitudes in the community. Campaigns and policies should go beyond dispelling myths about HIV transmission and immorality to innovate peer-led and couples-based stigma reduction programming in the ANC space

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Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort)

BMJ Open ◽

10.1136/bmjopen-2018-027325 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027325

Author(s):

Juan Liu ◽

James Wilton ◽

Ashleigh Sullivan ◽

Alex Marchand-Austin ◽

Beth Rachlis ◽

...

Keyword(s):

Diagnostic Tests ◽

Retrospective Cohort ◽

Laboratory Data ◽

Population Based ◽

Hiv Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Laboratory Test Results ◽

Living With Hiv

PurposePopulation-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada.ParticipantsA datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985–2015) or VL test (1996–2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration.Findings to dateAs of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort—contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015.Future plansWe plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities.

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Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention

BMJ Open ◽

10.1136/bmjopen-2019-029748 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029748 ◽

Cited By ~ 1

Author(s):

Judy H Ha ◽

Lynn M Van Lith ◽

Elizabeth C Mallalieu ◽

Jose Chidassicua ◽

Maria Dirce Pinho ◽

...

Keyword(s):

Hiv Testing ◽

Sub Saharan Africa ◽

Hiv Stigma ◽

Hiv Care ◽

People Living With Hiv ◽

Community Group ◽

Cross Sectional ◽

Men And Women ◽

Sub Saharan ◽

The Relationship

ObjectivesIncreasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing.Design and settingA cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique.ParticipantsData were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731).MeasuresMeasures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates.ResultsSignificantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women.ConclusionsMen have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men’s engagement into the HIV care continuum in sub-Saharan Africa.

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Low Proportion of Women who came knowing their HIV Status at First Antenatal Care Visit, Uganda, 2012-2016: A Descriptive Analysis of Surveillance Data

10.21203/rs.2.12401/v1 ◽

2019 ◽

Author(s):

Miriam Nakanwagi ◽

Lilian Bulage ◽

Benon Kwesiga ◽

Alex Riolexus Ario ◽

Doreen Agasha Birungi ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Hiv Testing ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Status ◽

Antenatal Care Visit ◽

Care Visit ◽

Hiv Test ◽

Significant Difference

Abstract Background HIV testing is the cornerstone for all HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). The earlier women of reproductive age know their HIV status, the better informed their reproductive decisions and their infants’ outcomes may be. We analyzed trends in known current HIV status among pregnant women attending their first antenatal care visit (ANC1) in Uganda, 2012-2016. Methods We conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC1 during 2012-2016. Women who brought documentation with them to ANC1 of an HIV test within the previous four weeks or an HIV care card as evidence of being in HIV care were considered as knowing their HIV status in antenatal care clinics. We calculated proportions of women with known current HIV status at ANC1, and described the linear trends both nationally and regionally. We used improved Poisson regression with generalized linear models to test the statistical significance of the trend. Results There was no significant difference in the number of women that attended ANC1 visits over the years 2012 to 2016. The proportion of women that came with known HIV status was highest at 6.9% in 2016 and this was an increasing trend (p<0.001). Most of the regions had an increase in trend except the West Nile and Mid-Eastern (p<0.001). The proportion of women that came knowing their HIV positive status at ANC1 is slightly higher than that of women that were newly tested HIV positive at ANC1 in 2015 and 2016. Conclusion Although the gap in women that come at ANC1 without knowing their HIV positive status might be reducing, still a large proportion of women who were infected with HIV did not know their status before their ANC1 HIV test, indicating a major public health gap. Therefore, more efforts are still required to achieve full PMTCT. In light of the considerable number that comes not knowing their HIV positive status at ANC1, we recommend advocacy for early ANC attendance and hence HIV testing so that timely PMTCT interventions can be made.

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Low Proportion of Women who came knowing their HIV Status at First Antenatal Care Visit, Uganda, 2012-2016: A Descriptive Analysis of Surveillance Data

10.21203/rs.2.12401/v2 ◽

2020 ◽

Author(s):

Miriam Nakanwagi ◽

Lilian Bulage ◽

Benon Kwesiga ◽

Alex Riolexus Ario ◽

Doreen Agasha Birungi ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Hiv Testing ◽

Statistical Significance ◽

Reproductive Age ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Status ◽

Significant Difference ◽

Test Result

Abstract Background: HIV testing is the cornerstone for HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). Knowledge of HIV status is associated with better reproductive health choices and outcomes for the infant’s HIV status. We analyzed trends in known current HIV status among pregnant women attending the first antenatal care (ANC) visit in Uganda, 2012-2016. Methods: We conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC visit during 2012-2016. Women who brought documented HIV negative test result within the previous four weeks at the first ANC visit or an HIV positive test result and/or own HIV care card were considered as knowing their HIV status. We calculated proportions of women with known current HIV status at first ANC visit, and described linear trends both nationally and regionally. We tested statistical significance of the trend using modified Poisson regression with generalized linear models. For known HIV positive status, we only analyzed data for years 2015-2016 because this is when this data became available. Results: There was no significant difference in the number of women that attended first ANC visits over years 2012-2016. The proportion of women that came with known HIV status increased from 4.4% in 2012 to 6.9% in 2016 and this increase was statistically significant (p<0.001). Most regions had an increase in trend except the West Nile and Mid-Eastern (p<0.001). The proportion of women that came knowing their HIV positive status at first ANC visit was slightly higher than that of women that were newly tested HIV positive at first ANC visit in 2015 and 2016. Conclusion: Although the gap in women that come at first ANC visit without knowing their HIV positive status might be reducing, a large proportion of women who were infected with HIV did not know their status before the first ANC visit indicating a major public health gap. We recommend advocacy for early ANC attendance and hence timely HIV testing and innovations to promptly identify HIV positive women of reproductive age so that timely PMTCT interventions can be made.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158031 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8031

Author(s):

Dharma N. Bhatta ◽

Jennifer Hecht ◽

Shelley N. Facente

Keyword(s):

Mental Health ◽

San Francisco ◽

Age Groups ◽

Hiv Stigma ◽

Hiv Care ◽

People Living With Hiv ◽

Cross Sectional ◽

Adjusted Risk ◽

Sex With Men ◽

Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

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