a HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
b Department of Research & Innovation , University of Limpopo , Sovenga , South Africa.
SAHARA J. 2018 Dec;15(1):80-88. doi: 10.1080/17290376.2018.1510787.
We evaluate the impact a multicomponent, behavioural, prevention of mother to child transmission (PMTCT), cluster randomised controlled trial on HIV stigma reduction among perinatal HIV infected women in rural South Africa.
In a cluster randomised controlled trial, twelve community health centres (CHCs) in Mpumalanga Province, South Africa, were randomised; pregnant women living with HIV enrolled received either: A Standard Care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n =357), or an Enhanced Intervention (EI) condition of SC PMTCT plus the 'Protect Your Family' intervention (EI; 6 CHCs; n =342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions; those in the EI, four antenatal and two postnatal group PMTCT sessions, including stigma reduction, led by trained lay health workers. Maternal PMTCT, HIV knowledge and HIV related stigma were assessed. The impact of the EI was ascertained on stigma reduction (baseline, 12 months postnatally). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention.
In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed prenatally at baseline and at 12 months (59.5%) postnatally. Baseline scores of overall HIV related stigma and the four scale factors (personalised stigma, disclosure concerns, negative self-image, and concern public attitudes) decreased at follow-up in the intervention group, while baseline scores of overall stigma and three scale factors (personalised stigma, negative self-image, and concern public attitudes) increased at follow-up in the control group. Using longitudinal analyses, Model 1, which included time-invariant predictors of stigma assessed over the two time periods of baseline and 12 months, increases in stigma from baseline to 12 months were associated with being unemployed, having been diagnosed with HIV before the current pregnancy, and alcohol use. In Model 2, which included time-varying predictors, lower stigma scores were associated with participation in the intervention, greater male partner involvement, and consistent condom use.
The enhanced PMTCT intervention, including stigma reduction, administered by trained lay health workers had a significant effect on the reduction of HIV related stigma.
clinicaltrials.gov: number NCT02085356.
我们评估了一项多组分、行为学的预防母婴传播（PMTCT）的集群随机对照试验，该试验对南非农村地区围产期感染艾滋病毒的妇女的艾滋病毒耻辱感减少的影响。
在一项集群随机对照试验中，南非姆普马兰加省的 12 个社区卫生中心（CHC）被随机分配；接受治疗的感染艾滋病毒的孕妇接受以下两种治疗之一：标准护理（SC）条件加上疾病预防的等效关注控制（SC；6 个 CHC；n = 357），或 SC PMTCT 加上“保护您的家人”干预（EI）条件（EI；6 个 CHC；n = 342）。接受 SC 的艾滋病毒感染孕妇参加了四次产前和两次产后视频会议；接受 EI 的孕妇参加了四次产前和两次产后小组 PMTCT 会议，包括由经过培训的基层卫生工作者进行的耻辱感减少。评估了产妇 PMTCT、艾滋病毒知识和与艾滋病毒相关的耻辱感。确定 EI 在减少耻辱感方面的影响（基线，产后 12 个月）。开发了一系列逻辑回归和潜在增长曲线模型，以检验干预的影响。
共有 699 名感染艾滋病毒的孕妇在妊娠 8-24 周时被招募，在产前基线和产后 12 个月（59.5%）进行了评估。在干预组中，在随访中，与艾滋病毒相关的耻辱感的整体和四个量表因素（个人耻辱感、披露担忧、负面自我形象和对公众态度的关注）的基线评分下降，而在对照组中，与艾滋病毒相关的耻辱感的整体和三个量表因素（个人耻辱感、负面自我形象和对公众态度的关注）的基线评分增加。使用纵向分析，模型 1 包括在基线和 12 个月两个时间段评估的耻辱感的时间不变预测因子，从基线到 12 个月的耻辱感增加与失业、在当前妊娠前被诊断出患有 HIV 以及饮酒有关。在模型 2 中，包括时间变化的预测因子，较低的耻辱感评分与参与干预、更大的男性伴侣参与和持续使用避孕套有关。
由经过培训的基层卫生工作者实施的强化 PMTCT 干预，包括减少耻辱感，对减少与艾滋病毒相关的耻辱感有显著影响。
clinicaltrials.gov：编号 NCT02085356。
