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Outcomes of the MAMA Training: A Simulation and Experiential Learning Intervention for Labor and Delivery Providers to Improve Respectful Maternity Care for Women Living with HIV in Tanzania

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Abstract

Respectful maternity care (RMC) for women living with HIV (WLHIV) improves birth outcomes and may influence women’s long-term commitment to HIV care. In this study, we evaluated the MAMA training, a team-based simulation training for labor and delivery (L&D) providers to improve RMC and reduce stigma in caring for WLHIV. The study was conducted in six clinical sites in the Kilimanjaro Region of Tanzania. 60 L&D providers participated in the MAMA training, which included a two-and-a-half-day workshop followed by a half-day on-site refresher. We assessed the impact of the MAMA training using a pre-post quasi-experimental design. To assess provider impacts, participants completed assessments at baseline and post-intervention periods, measuring RMC practices, HIV stigma, and self-efficacy to provide care. To evaluate patient impacts, we enrolled birthing women at the study facilities in the pre- (n = 229) and post- (n = 214) intervention periods and assessed self-reported RMC and perceptions of provider HIV stigma. We also collected facility-level data on the proportion of patients who gave birth by cesarean section, disaggregated by HIV status. The intervention had a positive impact on all provider outcomes; providers reported using more RMC practices, lower levels of HIV stigma, and greater self-efficacy to provide care for WLHIV. We did not observe differences in self-reported patient outcomes. In facility-level data, we observed a trend in reduction in cesarean section rates for WLHIV (33.0% vs. 24.1%, p = 0.14). The findings suggest that the MAMA training may improve providers’ attitudes and practices in caring for WLHIV giving birth and should be considered for scale-up.

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Funding

This study was supported by Fogarty International Center (Grant Nos. R21 TW012001, D43 TW010543).

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Authors and Affiliations

  1. Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA

    Melissa H. Watt, Maya J. Stephens & Olivia R. Hanson

  2. School of Medicine, Duke University, Durham, NC, USA

    Virginie Marchand

  3. Kilimanjaro Christian Medical University College, Moshi, Tanzania

    Mariam L. Barabara, Pendo S. Mlay, Gaudensia A. Olomi & Blandina T. Mmbaga

  4. Kilimanjaro Clinical Research Institute, Moshi, Tanzania

    Mariam L. Barabara, Linda M. Minja, Janeth F. Kiwia & Blandina T. Mmbaga

  5. Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania

    Pendo S. Mlay

  6. Regional Secretary of Kilimanjaro - Health Department, Moshi, Tanzania

    Gaudensia A. Olomi

  7. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA

    Susanna R. Cohen

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  1. Melissa H. Watt
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Watt, M.H., Marchand, V., Barabara, M.L. et al. Outcomes of the MAMA Training: A Simulation and Experiential Learning Intervention for Labor and Delivery Providers to Improve Respectful Maternity Care for Women Living with HIV in Tanzania. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04283-5

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