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Hanson OR, Weglarz AJ, Barabara ML, Cohen SR, Minja LM, Mlay PS, Stephens MJ, Olomi GA, Mlay J, Mmbaga BT, Watt MH. HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study. AIDS Behav 2024:10.1007/s10461-024-04322-1. [PMID: 38526642 DOI: 10.1007/s10461-024-04322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48 h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame (Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).
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Affiliation(s)
- Olivia R Hanson
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Anya J Weglarz
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Susanna R Cohen
- Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo S Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J Stephens
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Gaudensia A Olomi
- Health Management Department, Kilimanjaro Regional Secretary's Office, Moshi, Tanzania
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Melissa H Watt
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Barabara ML, Cohen SR, Masenga G, Minja LM, Mlay PS, Stephens MJ, Olomi GA, Mlay J, Marchand V, Weglarz A, Hanson O, Mmbaga BT, Watt MH. Factors associated with respectful maternity care and influence of HIV status among women giving birth in Kilimanjaro, Tanzania. Birth 2023. [PMID: 37902177 DOI: 10.1111/birt.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/25/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Respectful maternity care (RMC) is a rights-based approach to childbirth that centers the dignity, autonomy, and well-being of birthing women. This study aimed to examine factors associated with RMC among women giving birth in Tanzania and to examine whether HIV status was associated with self-reported RMC. METHODS We enrolled 229 postpartum women in six clinics in the Kilimanjaro Region; of them, 103 were living with HIV. Participants completed a survey within 48 h after birth before being discharged. RMC was measured using a 30-item scale with three subscales (dignity and respect; supportive care; communication and autonomy), each standardized from 0 to 100. Univariable and multivariable regression models examined factors associated with RMC. RESULTS The median score of the full RMC score was 74, differing slightly by subscale: 83 for dignity and respect, 76 for supportive care, and 67 for communication and autonomy. RMC did not differ by HIV status (median 67.0 vs. 67.0, p = 0.89). In multivariable linear regression, women who would not recommend the birth facility to their friends and who did not receive breastfeeding education had significantly lower RMC scores on the full RMC scale. In the dignity and respect subscale, variables associated with significantly lower RMC scores were not being able to read and write, delivering in a public facility, and delivering vaginally. CONCLUSIONS Although self-reported RMC was generally high, we identified areas for improvement. Practitioners need ongoing training on RMC principles and the delivery of equitable care.
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Affiliation(s)
| | - Susanna R Cohen
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake, Utah, USA
| | - Gileard Masenga
- Kilimanjaro Christian Medical Center Consultant Hospital, Moshi, Tanzania
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo S Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J Stephens
- Department of Population Health Sciences, University of Utah, Salt Lake, Utah, USA
| | - Gaudensia A Olomi
- Health Management Department, Kilimanjaro Regional Secretary's Office, Moshi, Tanzania
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Anya Weglarz
- Department of Population Health Sciences, University of Utah, Salt Lake, Utah, USA
| | - Olivia Hanson
- Department of Population Health Sciences, University of Utah, Salt Lake, Utah, USA
| | | | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake, Utah, USA
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Marchand V, Watt MH, Minja LM, Barabara ML, Mlay J, Stephens MJ, Hanson O, Mmbaga BT, Cohen SR. Burnout among labor and birth providers in northern Tanzania: A mixed-method study. medRxiv 2023:2023.05.28.23290395. [PMID: 37398023 PMCID: PMC10312826 DOI: 10.1101/2023.05.28.23290395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally, and is especially worrisome in settings with a shortage of healthcare workers and resources. The goal of this study is to explore the experience of burnout in a population of labor and delivery (L&D) providers in Tanzania. We examined burnout using three data sources. A structured assessment of burnout was collected at four time points from a sample of 60 L&D providers in six clinics. The same providers participated in an interactive group activity from which we drew observational data on burnout prevalence. Finally, we conducted in-depth interviews (IDIs) with a subset of 15 providers to further explore their experience of burnout. At baseline, prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One- and three- months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped providers realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors. Burnout was prevalent among a sample of L&D providers in northern Tanzania. However, a lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health. Previously validated burnout measures cannot adequately assess burnout without a discussion of the context.
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Affiliation(s)
| | - Melissa H Watt
- University of Utah, Department of Population Health Sciences, Salt Lake City, Utah, USA
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Maya J Stephens
- University of Utah, Department of Population Health Sciences, Salt Lake City, Utah, USA
| | - Olivia Hanson
- University of Utah, Department of Population Health Sciences, Salt Lake City, Utah, USA
| | | | - Susanna R Cohen
- University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, Utah, USA
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Watt MH, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT, Hanson OR, Cohen SR. 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. BMC Pregnancy Childbirth 2023; 23:181. [PMID: 36927460 PMCID: PMC10018883 DOI: 10.1186/s12884-023-05482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
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.
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Affiliation(s)
- Melissa H. Watt
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Linda M. Minja
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Mariam Barabara
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo Mlay
- grid.415218.b0000 0004 0648 072XDepartment of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J. Stephens
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | | | - Janeth Mlay
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Virginie Marchand
- grid.26009.3d0000 0004 1936 7961School of Medicine, Duke University, Durham NC, USA
| | - Blandina T. Mmbaga
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Olivia R. Hanson
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Susanna R. Cohen
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT USA
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Watt MH, Cohen SR, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT. 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. Res Sq 2023:rs.3.rs-2285235. [PMID: 36778232 PMCID: PMC9915785 DOI: 10.21203/rs.3.rs-2285235/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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 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.
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Kapiga SH, Sam NE, Mlay J, Aboud S, Ballard RC, Shao JF, Larsen U. The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care 2006; 18:379-87. [PMID: 16809117 DOI: 10.1080/09540120500465012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We conducted a community-based study to determine the predictors of HIV-1 among women aged 20-44 years (N = 1,418) and their regular male partners (N = 566) from randomly selected households in Moshi, Tanzania. The weighted prevalence of HIV-1 was 10.3% in women and 7% in men. The highest risk of HIV-1 was in subjects whose partners were HIV-1 seropositive in both women (adjusted odds ratio (AOR) = 26.63; 95% confidence interval (CI): 10.74-66.02) and men (AOR = 22.25; 95%CI: 7.06-70.15). Herpes simplex virus type 2 (HSV-2) and Mycoplasma genitalium were also significantly associated with HIV-1. Women with male partners >or=12 years older than themselves had increased risk of HIV-1 (AOR = 1.99; 95%CI: 1.01-7.85). Other predictors of HIV-1 were history of infertility and the number of sex partners in the last three years in women and the age at time of circumcision and history of past sexually transmitted diseases (STDs) in male partners. These findings show that HIV-1/STDs were major public health problems among women and their long-term partners in this population. HIV-1 prevention efforts should include promotion of couple's HIV-1 counseling and testing services, control of HSV-2, promotion of safer sexual practices and strategies to reduce the age difference between women and their partners.
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Affiliation(s)
- S H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
BACKGROUND Previous research on the aetiology of infertility in sub-Saharan Africa was generally clinic based and it is not known whether findings from this work are representative of the general population. A better understanding of the medical causes of infertility is crucial for reducing the incidence of infertility and for improving the clinical management. OBJECTIVE To determine the type and aetiology of infertility in a community and clinic-based sample. DESIGN Couples identified as infertile in a representative cross-sectional survey from a community-based sample of 2019 women aged 20-44 years and couples seeking care for infertility at a tertiary health facility. SETTING The community-based sample was drawn from Moshi Urban District and the clinic-based sample from patients seeking care at Kilimanjaro Christian Medical Centre (KCMC) in 2002 and 2003. PARTICIPANTS Sixty six couples identified as infertile in the community-based sample and 112 couples seeking care for infertility. RESULTS The percentage of primary infertility was 37.1% and secondary infertility was 62.9%. Female only factor infertility was identified in 65.9% of the couples, male only factor in 6.8%, male and female factors in 15.2% and unexplained infertility in 12.1%. CONCLUSION The type and aetiology of infertility were the same in the community and clinic-based sample suggesting that the couples seeking infertility health care were representative of the general infertile population. Tubal factor infertility was the commonest cause.
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Affiliation(s)
- U Larsen
- Department of Population and International Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
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Affiliation(s)
- U Larsen
- Department of Population and International Health, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, USA.
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