Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania

Watt, Melissa H.; Minja, Linda; Knettel, Brandon A.; Mwamba, Rimel N.; Osaki, Haika; Ngocho, James Samwel; Kisigo, Godfrey; Renju, Jenny; Vissoci, João Ricardo Nickenig; Sao, Saumya S.; Mmbaga, Blandina T.

doi:10.1007/s10461-020-03093-9

Cited by 18 publications

(14 citation statements)

References 56 publications

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“…Notably, only two papers presented age-disaggregated results [26,27] and one additional paper noted that age did not modify the study results [28]. Among all 37 papers evaluating at least one approach to increase retention, 18 demonstrated no effect on retention [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 19 reported a significant effect on retention [26][27][28][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Notably, several papers reported significant improvements in retention at some time points but not at others; these are categorized as reporting a significant effect on retention.…”

Section: Resultsmentioning

confidence: 99%

“…One study was published during 2010 [30], but the remainder were published between 2014 and 2020. Cluster-randomized controlled trials were the most common study design [29,32,[34][35][36][37]39,40,43,47,[56][57][58], and the duration of follow-up across studies ranged from one month [28,30,33,61] to 36 to 60 months' postpartum [38], with two-thirds of studies following women through ≤6 months' postpartum [27,28,30,31,33,[35][36][37][39][40][41][43][44][45]47,48,50,[53][54][55][56][59][60][61][62]. Many studies were restricted to women who were not yet receiving ART when presenting for ANC or delivery, and 12 studies were restricted to women who were aged ≥18 years at enrolment in the study [26,28,29,…”

Section: Resultsmentioning

confidence: 99%

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Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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Introduction: Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. Methods: Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported agedisaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. Results and discussion: Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. Conclusions: This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/ or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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“…Despite its shortcomings, the structure of the CBHS program remains solid, and the CHWs are motivated and eager for additional support. These findings point to several promising avenues for future program improvement, including regular refresher training that incorporates new topics and skills, including counseling skills, stigma reduction strategies, support for HIV disclosure, and screening for comorbid mental health challenges (Neve et al, 2017;Watt et al, 2020). To address privacy concerns, CHWs may seek to facilitate opportunities for peer support among patients, which has been shown to both reduce the stigma associated with seeking care and improve patient outcomes (Grimsrud et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania

Knettel¹,

Fernandez²,

Wanda³

et al. 2021

J Assoc Nurses AIDS Care

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Suboptimal retention in HIV care is a major driver of the global epidemic, including in sub-Saharan Africa. In Tanzania, the national Community-Based HIV Services program integrates volunteer community health workers (CHWs) to support patient care engagement and reduce the burden placed on HIV clinic nurses; however, few studies have assessed the value of CHWs supporting HIV care. Qualitative interviews were conducted with 48 administrators, nurses, CHWs, and patients to explore strengths and limitations of the Community-Based HIV Services program. Stakeholders believed CHWs are uniquely positioned to establish trust and provide patient support. Patients who had frequent contact with CHWs described them as valued sources of education and encouragement, but fewer than half of the patients interviewed had ever met with a CHW. Clinic nurses described feeling disconnected from CHWs, and stakeholders highlighted the need for financial, logistical, and educational support to rejuvenate the program and effectively address care engagement challenges.

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“…Being able to distinguish between these two domains of stigma is important in the evaluation of stigma reduction interventions. In our team’s intervention work, we found that a stigma reduction intervention in ANC had a positive impact on moral judgment toward PLWH, but did not impact attitudes about interpersonal distancing and social isolation [ 54 ]. While knowledge about HIV, including modes of transmission, increased over time [ 55 ], this may not translate into behavior change.…”

Section: Discussionmentioning

confidence: 99%

The Development and Psychometric Evaluation of the HIV Stigmatizing Attitudes Scale (HSAS) in Tanzania

et al. 2021

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Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania

Cited by 18 publications

References 56 publications

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania

The Development and Psychometric Evaluation of the HIV Stigmatizing Attitudes Scale (HSAS) in Tanzania

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