# A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania

> **NIH NIH R21** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2022 · $206,700

## Abstract

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.

## Key facts

- **NIH application ID:** 10466969
- **Project number:** 5R21TW012001-02
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** Susanna Rose Cohen
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $206,700
- **Award type:** 5
- **Project period:** 2021-08-16 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10466969

## Citation

> US National Institutes of Health, RePORTER application 10466969, A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania (5R21TW012001-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10466969. Licensed CC0.

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