We Are Together (WAT):Development and testing of an intervention to reduce HIV-related stigma among pregnant and postpartum women

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.