PROJECT SUMMARY / ABSTRACT HIV stigma during the intrapartum period can impact birth outcomes for women living with HIV (WLHIV) and influence women’s long-term commitment to HIV care. Despite evidence that labor and delivery (L&D) providers may deliver suboptimal and stigmatizing care to WLHIV, no interventions exist to address HIV stigma among L&D providers. The proposed study will fill this gap by developing a simulation training intervention for L&D providers. The intervention is designed to address providers’ instrumental stigma by building the clinical skills and self-efficacy to manage routine births and obstetric emergencies in WLHIV, and address attitudinal stigma by building capacity for clinical empathy and self-reflection. The study is grounded in a conceptual model that respectful, non-stigmatizing maternity care can improve WLHIV’s trust in the medical system and in turn their commitment to long-term engagement in HIV care. In AIM 1, we will examine the manifestations of HIV stigma during the intrapartum period using robust qualitative methods, including in-depth interviews, focus group discussions, observations of childbirth, and facility assessments. In AIM 2, we will develop MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth) by adapting the evidence- based PRONTO International curriculum of simulation training to improve evidence-based management of birth and respectful maternity care (RMC). Using iterative methods of the ADAPT-ITT model, we will build on local contextual issues and examples gleaned from Aim 1 to develop content specific to promoting respectful, non-stigmatizing birth for WLHIV. In AIM 3, we will pilot test the MAMA intervention with L&D providers at six clinics in the Kilimanjaro Region of Tanzania. Pre- and post-surveys with providers (n=60) will assess RMC practices, instrumental stigma and stigmatizing attitudes. Surveys and medical record review with WLHIV who give birth in the study clinics will be compared in the pre-training and the post-training periods (n=206), examining RMC as a primary outcome. The Proctor framework will guide feasibility and acceptability metrics. Capacity building activities with our collaborating partner (Kilimanjaro Christian Medical Center) will be integrated throughout the grant period. Upon completion of the study, we will have the experience and data to inform a multi-site RCT that is powered to detect impacts on postpartum HIV care engagement. We are confident that this developmental work will significantly enhance the probability of success of a larger trial, and that it addresses the priorities of Fogarty to develop high-impact interventions to mitigate the impact of HIV stigma.