Acceptability, Suitability, and Feasibility of an Evidence-Based Intervention to Reduce HIV Risk Behaviors: Engaging Comadronas in HIV Prevention in Rural Guatemala.

This study addresses rural Guatemala's poor maternal health and HIV status by culturally adapting an evidence-based HIV intervention, SEPA (Self-Care, Education, Prevention, Self-Care), to extend the capacity of comadronas (Mayan birth attendants) as HIV prevention providers. This mixed-method study examined the acceptability, suitability, and feasibility of SEPA presented to traditional elder and a younger cohort of comadronas over three sessions. Outcome variables were reported as mean scores. Open-ended qualitative responses were categorized under central themes. Session 1, 2, and 3 acceptability (4.6/5, 4.6/5, 4.8/5), suitability (4.7/5, 4.6/5, 4.9/5), and feasibility (4.4/5, 4.7/5, 4.8/5) remained high across sessions. While comadronas reported that information was difficult, they reported high levels of understanding and comfort with SEPA content and they also found it to be culturally appropriate, increasing their confidence to discuss HIV with their community. The broader utilization of comadronas could create a pathway to enhance reproductive health among indigenous women.