Pilot Outcomes of Maisha : An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania
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ORIGINAL PAPER
Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania Melissa H. Watt1,3 · Linda Minja2 · Brandon A. Knettel3,7 · Rimel N. Mwamba3 · Haika Osaki2 · James S. Ngocho4 · Godfrey A. Kisigo2 · Jenny Renju5,6 · Joao R. N. Vissoci3 · Saumya S. Sao3 · Blandina T. Mmbaga2,3 Accepted: 8 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract HIV stigma is a persistent barrier to curbing the spread of HIV and improving quality of life for people living with HIV. We developed and pilot tested Maisha, an HIV stigma reduction intervention in antenatal care (ANC) with two objectives: 1) among individuals living with HIV, reduce internalized and anticipated HIV stigma, with subsequent improvements in HIV care engagement, and 2) among individuals who are HIV-seronegative, reduce HIV stigmatizing attitudes. We enrolled and baselined 1039 women and 492 male partners presenting to a first ANC appointment and randomized them to standard of care or the Maisha intervention. All women living with HIV (WLHIV) and a subset of HIV-negative participants completed a 3-month follow-up assessment. Participation in the three Maisha sessions was high (99.6%, 92.8%, 89.3%), and nearly all participants noted satisfaction with the intervention content (99.8%) and counselor (99.8%). Among 55 WLHIV, care engagement outcomes did not differ by condition. Among 293 HIV-negative participants, Maisha participants had significantly greater reductions in the moral judgment sub-scale of the stigma attitudes measure (p 80% satisfaction used as a metric of acceptability. Open-ended questions were thematically coded to summarize participants’ perceptions of the intervention, suggestions for changes, and feasibility moving forward. A coding structure for the qualitative data was proposed by GK based on a careful reading of the data, and confirmed through consultation with the first author. Coding was conducted by a single individual (GK), a Tanzanian national who had previously served as the study coordinator and was familiar with the intervention content and structure. Prior to initiating analysis of efficacy, we examined whether differences existed between the intervention and control conditions, using chi-square tests (for categorical variables) and t-tests (for continuous variables). Potential efficacy of the intervention was examined using an intentto-treat approach. Analysis was conducted separately among WLHIV, and individuals (women and men) who were identified as HIV-negative. For WLHIV (n = 55), chi-square tests were used to assess differences between conditions in the proportion of participants who were retained in HIV care at 3 months post enrollment. For women who presented to care with an established HIV diagnosis and completed follow-up (n = 29), we used profile plots to display changes from baseline to 3 months in internalized stigma, anticipated stigma, depression and HIV acceptance. For participants who were identified as HIV negative and com
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