Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial
Background South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evide...
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| Veröffentlicht in: | International journal of behavioral medicine 2023-02, Vol.30 (1), p.62-76 |
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| container_title | International journal of behavioral medicine |
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| creator | Psaros, Christina Stanton, Amelia M. Raggio, Greer A. Mosery, Nzwakie Goodman, Georgia R. Briggs, Elsa S. Williams, Marcel Bangsberg, David Smit, Jenni Safren, Steven A. |
| description | Background
South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking.
Method
Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview.
Results
Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment,
β
= − 11.1,
t
(24) = − 3.1,
p
|
| doi_str_mv | 10.1007/s12529-022-10071-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9452601</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2637582672</sourcerecordid><originalsourceid>FETCH-LOGICAL-c430t-f496a5e602454c8ee70f6e27924b512ccd7a52c6983ed4b3d46090c762752bcb3</originalsourceid><addsrcrecordid>eNp9UU1v1DAQtRCIlsIf4IAsceES8EccbzggrZaPVirqCgIcLceZ7Lpy7K2dgLpHfjkOW8rHgYM1M3pv3sz4IfSYkueUEPkiUSZYXRDGirmmxf4OOqaCs0IKsbibcyJJIQThR-hBSpeEECEluY-OuGAVqUt5jL5f7EY72L31G7x-36wavOy2EMEbwO01biLoccZewy5CSjZ4bD1eQ7Rej9rhL2EAj7_ZcYtPzz7P2Mcw5WLZR2v0S7zEa-vCiD9o34U8Bzq8Cn6MwbmcNtFq9xDd67VL8OgmnqBPb980q9Pi_OLd2Wp5XpiSk7Hoy7rSAirCSlGaBYAkfQVM1qxsBWXGdFILZqp6waErW96V-URiZMWkYK1p-Ql6ddDdTe0AnYG8hnZqF-2g47UK2qq_EW-3ahO-qrqcv4tmgWc3AjFcTZBGNdhkwDntIUxJsYpLsWCVZJn69B_qZZiiz-cpJvOK85tZ7MAyMaQUob9dhhI1W6oOFqts8c-aqn1uevLnGbctvzzNBH4gpAz5DcTfs_8j-wMW7LK6</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2769876982</pqid></control><display><type>article</type><title>Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Psaros, Christina ; Stanton, Amelia M. ; Raggio, Greer A. ; Mosery, Nzwakie ; Goodman, Georgia R. ; Briggs, Elsa S. ; Williams, Marcel ; Bangsberg, David ; Smit, Jenni ; Safren, Steven A.</creator><creatorcontrib>Psaros, Christina ; Stanton, Amelia M. ; Raggio, Greer A. ; Mosery, Nzwakie ; Goodman, Georgia R. ; Briggs, Elsa S. ; Williams, Marcel ; Bangsberg, David ; Smit, Jenni ; Safren, Steven A.</creatorcontrib><description>Background
South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking.
Method
Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview.
Results
Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment,
β
= − 11.1,
t
(24) = − 3.1,
p
< 0.005, 95% CI [− 18.41, − 3.83], and 3 months,
β
= − 13.8,
t
(24) = − 3.3,
p
< 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired.
Conclusion
A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children.
Trial Registration
ClinicalTrials.gov identifier: NCT03069417. Protocol available at
https://clinicaltrials.gov/ct2/show/NCT03069417</description><identifier>ISSN: 1070-5503</identifier><identifier>EISSN: 1532-7558</identifier><identifier>DOI: 10.1007/s12529-022-10071-z</identifier><identifier>PMID: 35260947</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Anti-HIV Agents - therapeutic use ; Antiretroviral therapy ; Child ; Depression - drug therapy ; Family Medicine ; Female ; Full Length Manuscript ; General Practice ; Health Psychology ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Infectious Disease Transmission, Vertical ; Medication Adherence - psychology ; Medicine ; Medicine & Public Health ; Mental depression ; Middle Aged ; Pilot Projects ; Postpartum depression ; Pregnancy ; Prenatal depression ; Problem solving ; Social interactions ; South Africa - epidemiology ; Young Adult</subject><ispartof>International journal of behavioral medicine, 2023-02, Vol.30 (1), p.62-76</ispartof><rights>International Society of Behavioral Medicine 2022</rights><rights>2022. International Society of Behavioral Medicine.</rights><rights>International Society of Behavioral Medicine 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-f496a5e602454c8ee70f6e27924b512ccd7a52c6983ed4b3d46090c762752bcb3</citedby><cites>FETCH-LOGICAL-c430t-f496a5e602454c8ee70f6e27924b512ccd7a52c6983ed4b3d46090c762752bcb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12529-022-10071-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12529-022-10071-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,778,782,883,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35260947$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Psaros, Christina</creatorcontrib><creatorcontrib>Stanton, Amelia M.</creatorcontrib><creatorcontrib>Raggio, Greer A.</creatorcontrib><creatorcontrib>Mosery, Nzwakie</creatorcontrib><creatorcontrib>Goodman, Georgia R.</creatorcontrib><creatorcontrib>Briggs, Elsa S.</creatorcontrib><creatorcontrib>Williams, Marcel</creatorcontrib><creatorcontrib>Bangsberg, David</creatorcontrib><creatorcontrib>Smit, Jenni</creatorcontrib><creatorcontrib>Safren, Steven A.</creatorcontrib><title>Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial</title><title>International journal of behavioral medicine</title><addtitle>Int.J. Behav. Med</addtitle><addtitle>Int J Behav Med</addtitle><description>Background
South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking.
Method
Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview.
Results
Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment,
β
= − 11.1,
t
(24) = − 3.1,
p
< 0.005, 95% CI [− 18.41, − 3.83], and 3 months,
β
= − 13.8,
t
(24) = − 3.3,
p
< 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired.
Conclusion
A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children.
Trial Registration
ClinicalTrials.gov identifier: NCT03069417. Protocol available at
https://clinicaltrials.gov/ct2/show/NCT03069417</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral therapy</subject><subject>Child</subject><subject>Depression - drug therapy</subject><subject>Family Medicine</subject><subject>Female</subject><subject>Full Length Manuscript</subject><subject>General Practice</subject><subject>Health Psychology</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infectious Disease Transmission, Vertical</subject><subject>Medication Adherence - psychology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Pilot Projects</subject><subject>Postpartum depression</subject><subject>Pregnancy</subject><subject>Prenatal depression</subject><subject>Problem solving</subject><subject>Social interactions</subject><subject>South Africa - epidemiology</subject><subject>Young Adult</subject><issn>1070-5503</issn><issn>1532-7558</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UU1v1DAQtRCIlsIf4IAsceES8EccbzggrZaPVirqCgIcLceZ7Lpy7K2dgLpHfjkOW8rHgYM1M3pv3sz4IfSYkueUEPkiUSZYXRDGirmmxf4OOqaCs0IKsbibcyJJIQThR-hBSpeEECEluY-OuGAVqUt5jL5f7EY72L31G7x-36wavOy2EMEbwO01biLoccZewy5CSjZ4bD1eQ7Rej9rhL2EAj7_ZcYtPzz7P2Mcw5WLZR2v0S7zEa-vCiD9o34U8Bzq8Cn6MwbmcNtFq9xDd67VL8OgmnqBPb980q9Pi_OLd2Wp5XpiSk7Hoy7rSAirCSlGaBYAkfQVM1qxsBWXGdFILZqp6waErW96V-URiZMWkYK1p-Ql6ddDdTe0AnYG8hnZqF-2g47UK2qq_EW-3ahO-qrqcv4tmgWc3AjFcTZBGNdhkwDntIUxJsYpLsWCVZJn69B_qZZiiz-cpJvOK85tZ7MAyMaQUob9dhhI1W6oOFqts8c-aqn1uevLnGbctvzzNBH4gpAz5DcTfs_8j-wMW7LK6</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Psaros, Christina</creator><creator>Stanton, Amelia M.</creator><creator>Raggio, Greer A.</creator><creator>Mosery, Nzwakie</creator><creator>Goodman, Georgia R.</creator><creator>Briggs, Elsa S.</creator><creator>Williams, Marcel</creator><creator>Bangsberg, David</creator><creator>Smit, Jenni</creator><creator>Safren, Steven A.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230201</creationdate><title>Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial</title><author>Psaros, Christina ; Stanton, Amelia M. ; Raggio, Greer A. ; Mosery, Nzwakie ; Goodman, Georgia R. ; Briggs, Elsa S. ; Williams, Marcel ; Bangsberg, David ; Smit, Jenni ; Safren, Steven A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-f496a5e602454c8ee70f6e27924b512ccd7a52c6983ed4b3d46090c762752bcb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral therapy</topic><topic>Child</topic><topic>Depression - drug therapy</topic><topic>Family Medicine</topic><topic>Female</topic><topic>Full Length Manuscript</topic><topic>General Practice</topic><topic>Health Psychology</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infectious Disease Transmission, Vertical</topic><topic>Medication Adherence - psychology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Pilot Projects</topic><topic>Postpartum depression</topic><topic>Pregnancy</topic><topic>Prenatal depression</topic><topic>Problem solving</topic><topic>Social interactions</topic><topic>South Africa - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Psaros, Christina</creatorcontrib><creatorcontrib>Stanton, Amelia M.</creatorcontrib><creatorcontrib>Raggio, Greer A.</creatorcontrib><creatorcontrib>Mosery, Nzwakie</creatorcontrib><creatorcontrib>Goodman, Georgia R.</creatorcontrib><creatorcontrib>Briggs, Elsa S.</creatorcontrib><creatorcontrib>Williams, Marcel</creatorcontrib><creatorcontrib>Bangsberg, David</creatorcontrib><creatorcontrib>Smit, Jenni</creatorcontrib><creatorcontrib>Safren, Steven A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of behavioral medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Psaros, Christina</au><au>Stanton, Amelia M.</au><au>Raggio, Greer A.</au><au>Mosery, Nzwakie</au><au>Goodman, Georgia R.</au><au>Briggs, Elsa S.</au><au>Williams, Marcel</au><au>Bangsberg, David</au><au>Smit, Jenni</au><au>Safren, Steven A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial</atitle><jtitle>International journal of behavioral medicine</jtitle><stitle>Int.J. Behav. Med</stitle><addtitle>Int J Behav Med</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>30</volume><issue>1</issue><spage>62</spage><epage>76</epage><pages>62-76</pages><issn>1070-5503</issn><eissn>1532-7558</eissn><abstract>Background
South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking.
Method
Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview.
Results
Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment,
β
= − 11.1,
t
(24) = − 3.1,
p
< 0.005, 95% CI [− 18.41, − 3.83], and 3 months,
β
= − 13.8,
t
(24) = − 3.3,
p
< 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired.
Conclusion
A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children.
Trial Registration
ClinicalTrials.gov identifier: NCT03069417. Protocol available at
https://clinicaltrials.gov/ct2/show/NCT03069417</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35260947</pmid><doi>10.1007/s12529-022-10071-z</doi><tpages>15</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1070-5503 |
| ispartof | International journal of behavioral medicine, 2023-02, Vol.30 (1), p.62-76 |
| issn | 1070-5503 1532-7558 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9452601 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Anti-HIV Agents - therapeutic use Antiretroviral therapy Child Depression - drug therapy Family Medicine Female Full Length Manuscript General Practice Health Psychology HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - epidemiology Human immunodeficiency virus Humans Infectious Disease Transmission, Vertical Medication Adherence - psychology Medicine Medicine & Public Health Mental depression Middle Aged Pilot Projects Postpartum depression Pregnancy Prenatal depression Problem solving Social interactions South Africa - epidemiology Young Adult |
| title | Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial |
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