Participatory simulation training design: The MAMA interprofessional team-training program for obstetric care of pregnant individuals living with HIV in Tanzania.

Stigma towards women living with HIV (WLHIV) during childbirth can lead to suboptimal care and clinical outcomes. In this paper we describe the design of MAMA, a simulation team-training curriculum for labor and delivery (L&D) providers to reduce HIV stigma, provide more respectful maternity care (RMC), and improve clinical empathy.In order to adapt the PRONTO model of simulation training, we integrated and applied the ADAPT-ITT framework for systematic adaptation of evidence-based interventions (EBI) and participatory design principles to create a responsive and innovative program. This process ensured we met local needs through continuous and iterative input from stakeholders, enabling those who would benefit from the intervention to drive its creation.The final intervention is a 2.5 days workshop, followed by a 2-hour in-situ refresher in the providers' clinical setting. The training centers simulation scenarios, teamwork and communication activities, and interactive lessons on principles of RMC, HIV stigma, prevention of mother-to-child transmission, implicit bias, teamwork, clinical empathy, and coping with burnout.The ADAPT-ITT model, augmented by participatory design strategies, provides a systematic yet flexible process to adapt and contextualize EBIs. The use of these complementary approaches resulted in a locally grounded intervention to build provider confidence and skills caring for WLHIV giving birth and to improve RMC in facilities in Tanzania.NCT03600142.