RCT to reduce stigma & improve treatment adherence in HIV+ pregnant women in Botswana

Investigator: Valerie Jackson, MPH, PhD

Location(s): Botswana


Clinical training of community health workers and providing consultation before and after regarding clinical aspects of this intervention.

We targeted pregnant mothers' ART adherence in the postpartum period, a time when ART discontinuation is more likely to occur. We explored intervention effects on infants that are potentially linked to stigma reduction such as birth weight, preterm delivery and achieving developmental milestones. In tandem, we built 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.