The goal of this proposal is to conduct a randomized controlled trial to counter the culturally-salient aspects of HIV stigma and improve anti-retroviral treatment (ART) adherence in Botswana, which has among the highest prevalence of HIV worldwide. We seek to target pregnant mothers' ART adherence in the postpartum period, a time when ART discontinuation is more likely to occur. We explore the possibility of intervention effects on infants that are potentially linked to stigma reduction such as birth weight, preterm delivery and achieving developmental milestones. We also seek to build capacity to enable investigators to independently implement culturally-tailored HIV stigma interventions, which not only raises the capacity of Botswana, but has major public health significance by serving as a model for other countries for development and dissemination of anti-stigma interventions. To our knowledge this is the first project to systematically evaluate a contact- based RCT stigma intervention for people living with HIV/AIDS (PLWHA) in Sub-Saharan Africa. As such, we take advantage of a unique opportunity to conduct an RCT stigma intervention and build capacity in Botswana where we have completed initial work identifying culturally salient components of HIV stigma. Because national programs to provide free ART and prenatal care already exist, reducing stigma among newly-identified HIV+ mothers addresses a core barrier to postpartum ART adherence. This project leverages a pre-existing collaboration between New York University, University of Botswana, and University of Pennsylvania, among leading experts in stigma, mental illness, and HIV, and is the first to adapt an empirically-tested stigma intervention that has shown efficacy, for use in HIV+ groups. To advance this area, we will train 3 peer PLWHA to co-lead the stigma intervention and to build capacity to implement contact-based stigma interventions in Botswana. We propose to test feasibility of this culturally-tailored stigma intervention among approximately 220 newly-identified HIV+ primiparous women via a randomized control trial design. Participants will be randomized into the stigma intervention group and the control group (approximately 100 HIV+, pregnant mothers each). Our study leverages capacity building with a strong local research infrastructure to (1) maximize likelihood of success in a setting with a high HIV prevalence and national coverage of ART and antental treatment, and (2) to enable investigators in Botswana to independently initiate culturally-tailored HIV stigma projects and establish a stigma intervention center. This pilot intervention will provide valuable data for a large-scale randomized controlled trial to reduce stigma and improve postpartum ART adherence, and will advance capacity to empirically reduce stigma of HIV, serving as a model for other LMIC.
The goal of this proposal is to conduct a randomized controlled trial to counter the culturally-salient aspects of HIV stigma to improve anti-retroviral treatment (ART) adherence in Botswana, which has among the highest HIV prevalence in the world. We seek to target pregnant mothers' ART adherence in the postpartum period, a time where ART discontinuation is more likely to occur. We also seek to build capacity to improve stigma intervention with HIV which not only raises the capacity of Botswana, but has major public health significance by serving as model for other countries for development and dissemination of anti-stigma interventions.
