坦桑尼亚为分娩医护人员提供模拟和体验式学习干预，以消除艾滋病毒污名：MAMA 干预评估研究方案。
A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: study protocol for the evaluation of the MAMA intervention.
机构信息
Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT, 84102, USA.
Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
出版信息
BMC Pregnancy Childbirth. 2023 Mar 16;23(1):181. doi: 10.1186/s12884-023-05482-z.
BACKGROUND
The experience of HIV stigma during intrapartum care can impact women's trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to women living with HIV (WLHIV) can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers' instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV.
METHODS
The MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n = 103 WLHIV) and after (n = 103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n = 60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability.
DISCUSSION
The implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement.
TRIAL REGISTRATION
The trial is registered at clinicaltrials.gov, NCT05271903.
背景
在分娩期间经历艾滋病毒耻辱感会影响妇女对医疗保健系统的信任，并破坏她们对艾滋病毒护理参与的长期承诺。为艾滋病毒感染者（PLHIV）提供尊重产妇保健（RMC）可以改善生活质量和临床结局。本研究的目的是评估 MAMA（Mradi wa Afya ya Mama Mzazi，支持产妇健康项目，Project to Support the Health of Women Giving Birth），这是一种针对分娩提供者的模拟团队培训课程，旨在解决提供者对 PLHIV 的工具性和态度性耻辱感，并促进为 PLHIV 提供循证 RMC。
方法
MAMA 干预措施将在坦桑尼亚乞力马扎罗地区的六个诊所的医疗保健提供者中进行评估。为了评估 MAMA 的影响，我们将招募在干预前（n=103 名 PLHIV）和干预后（n=103 名 PLHIV）在这些设施中分娩的 PLHIV。我们将检查主要结局（对 RMC 的看法）和次要结局（产后 HIV 护理参与；对设施中 HIV 耻辱感的看法；内部 HIV 耻辱感；临床结局和循证实践）在两个时间段内登记的妇女之间的差异。还将在基线、即时后、培训后 1 个月和培训后 2 个月评估参与的提供者（n=60）。我们将检查主要结局（RMC 实践）和次要结局（对 PLHIV 的歧视；在分娩期间提供护理的自我效能）的纵向变化。将收集质量保证数据以评估干预的可行性和可接受性。
讨论
实施结果将用于最终确定可扩展的培训师培训模型的干预措施，而结局数据将用于为多地点研究提供动力，以检测 HIV 护理参与方面的显著差异。
试验注册
该试验在 clinicaltrials.gov 上注册，NCT05271903。
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