This is a randomized controlled trial to examine the efficacy of an integrated model of HIV post-test support for women attending the King Edward VIII Hospital (KEH) antenatal care (ANC) clinic in Durban, South Africa. The rates of HIV infection among pregnant women in South Africa are among the highest in the world. The government provides all women with access to antiretrovirals (ARV) during pregnancy to reduce transmission of HIV infection to infants. However, there is a growing recognition that the uptake and adherence to PMTCT programs could be improved and that the current programs largely overlook the enormous psychosocial challenges associated with testing pregnant women. The proposed intervention is designed to tailor VCT for the ANC setting and provide a continuum of psychosocial support through: (1) a health education video before HIV pre-test counseling;(2) HIV pre- and post-test counseling that prepares women for decisions related to HIV testing, HIV serostatus disclosure, infant feeding and ARV prophylaxis;(3) two additional post-test counseling sessions which coincide with 6 and 10-week postpartum visits and focus on infant health, sexual risk reduction, partner testing, and family planning and;(4) an active referral system to support groups run by an NGO affiliated with KEH. To accomplish this trial we will: (1) conduct ethnographic research to describe the determinants of key behaviors from the perspective of women and their male partners;(2) enroll and interview a cohort of 1,495 HIV-positive and HIV-negative participants to determine baseline biologic (Gonorrhea, Trichomonas vaginalis, Chlamydia), behavioral, and psychosocial characteristics;(3) randomize participants to standard VCT or standard VCT plus post-test support;(4) Follow participants 9-months post-partum to compare sexual risk (STI incidence, correct &consistent condom use, partner testing);factors associated with HIV mother to child transmission (acceptance of VCT and ARVs, infant feeding choices, family planning intention) and psychosocial outcomes (social support, emotional distress and partner violence) among participants who receive the VCT plus post-test support with participants who receive standard VCT. We hypothesize that the intervention will have a public health impact by expanding the preventive benefits of PMTCT programs while concurrently increasing the benefits and minimizing the psychosocial harms associated with VCT and HIV serostatus disclosure for women.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
3R01HD050134-05S1
Application #
8135859
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Newcomer, Susan
Project Start
2006-09-15
Project End
2012-08-31
Budget Start
2010-09-01
Budget End
2012-08-31
Support Year
5
Fiscal Year
2010
Total Cost
$406,249
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Miscellaneous
Type
Schools of Public Health
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Maise, Hopolang C; Moodley, Dhayendre; Sebitloane, Motshedisi et al. (2018) Prevalence, risk factors, and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting. Int J Gynaecol Obstet 140:105-110
Groves, Allison K; Reyes, H Luz McNaughton; Moodley, Dhayendre et al. (2018) HIV Positive Diagnosis During Pregnancy Increases Risk of IPV Postpartum Among Women with No History of IPV in Their Relationship. AIDS Behav 22:1750-1757
Hill, Lauren M; Maman, Suzanne; Holness, David et al. (2016) Legal knowledge, needs, and assistance seeking among HIV positive and negative women in Umlazi, South Africa. BMC Int Health Hum Rights 16:3
Maman, Suzanne; Groves, Allison K; McNaughton Reyes, H Luz et al. (2016) Diagnosis and Disclosure of HIV Status: Implications for Women's Risk of Physical Partner Violence in the Postpartum Period. J Acquir Immune Defic Syndr 72:546-51
Marlow, Heather M; Maman, Suzanne; Moodley, Dhayendre et al. (2015) HIV status and postpartum contraceptive use in an antenatal population in Durban, South Africa. Contraception 91:39-43
Groves, Allison K; Moodley, Dhayendre; McNaughton-Reyes, Luz et al. (2015) Prevalence, rates and correlates of intimate partner violence among South African women during pregnancy and the postpartum period. Matern Child Health J 19:487-95
Hill, Lauren M; Maman, Suzanne; Groves, Allison K et al. (2015) Social support among HIV-positive and HIV-negative adolescents in Umlazi, South Africa: changes in family and partner relationships during pregnancy and the postpartum period. BMC Pregnancy Childbirth 15:117
Moodley, Dhayendre; Moodley, Prashini; Sebitloane, Motshedisi et al. (2015) High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa. Sex Transm Dis 42:43-7
Maman, Suzanne; Moodley, Dhayendre; McNaughton-Reyes, Heathe Luz et al. (2014) Efficacy of enhanced HIV counseling for risk reduction during pregnancy and in the postpartum period: a randomized controlled trial. PLoS One 9:e97092
Marlow, Heather M; Maman, Suzanne; Moodley, Dhayendre et al. (2014) Postpartum family planning service provision in Durban, South Africa: client and provider perspectives. Health Care Women Int 35:175-99

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