Hiv
Conditions
Brief summary
Young pregnant and postpartum women living with HIV are at the greatest risk of disengagement from HIV services and suboptimal adherence to antiretroviral therapy (ART). Among young women, stigma is a major barrier to retention in services and adherence to ART, and interventions are needed to combat stigma and improve ART outcomes. The investigators are conducting a pilot study of a peer support intervention to mitigate the negative effects of stigma in this population.
Detailed description
Despite major reductions in mother-to-child HIV transmission (MTCT), young pregnant and postpartum women living with HIV remain a vulnerable group and experience the greatest risk of disengagement from services and suboptimal adherence to antiretroviral therapy (ART). HIV-related and intersectional stigmas are major barriers to uptake and retention in prevention of mother-to-child transmission (PMTCT) services and drive suboptimal adherence, and young women experience unique stigmas. Despite this, there are no evidence-based interventions to combat stigma and improve ART outcomes in this group. Peer support group interventions have shown promise in other populations, but have not been examined in young pregnant and postpartum women living with HIV. The investigators are conducting a pilot study of a peer support intervention to mitigate the negative effects of stigma in young pregnant and postpartum women living with HIV in South Africa. Participants will be allocated to the standard of care, in which no standardized peer support groups exist for this patient population, or to a peer support intervention.
Interventions
BEHAVIORALPeer support intervention
Peer support groups will meet monthly for the duration of follow-up, with separate groups for pregnant and postpartum women. Groups will be facilitated by women who are living with HIV and have experience of PMTCT services in this setting. Group sessions will include brief information and a structured discussion about a relevant topic, followed by opportunities for unstructured discussion.
Sponsors
University of Cape Town
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
16 Years to 24 Years
Healthy volunteers
No
Inclusion criteria
* Aged 16-24 years * Documented HIV infection * Confirmed pregnant or recently postpartum * Accessing antenatal or immediate postpartum PMTCT services at the study site * Planning on remaining a resident of Cape Town for at least 6 months after enrolment * Able to provide informed consent for research
Exclusion criteria
* Significant pre-existing psychiatric comorbidity that may impact ability to consent * Stated intention to move outside of Cape Town during the 6 months after enrolment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Retention and viral suppression | After 6 months of follow-up | Combined endpoint of (i) retention in HIV services and (ii) HIV viral suppression. Women will be considered to have achieved the primary outcome if they are both retained in care and virally suppressed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Psychosocial outcomes | 6 months | Psychosocial outcomes, including perceived social support and adherence self-efficacy, assessed using self-report questionnaires |
| Implementation of the intervention | 6 months | Implementation of the peer support intervention including standardization, assessed using logs and process notes completed by counsellors who will deliver the intervention |
| Acceptability of the intervention | 6 months | Acceptability of the peer support intervention, assessed as utilization and during in-depth interviews in a subset of participants |
| Health status | 6 months | Maternal and infant health status, assessed using self-report and routine medical records |
| Health service use | 6 months | Maternal and infant routine medical service use, assessed using self-report and routine medical records |
Countries
South Africa
Outcome results
None listed