Group Antenatal Care: Effectiveness for Maternal/Infant and HIV Prevention Outcomes and Contextual Factors Linked to Implementation Success in Malawi

团体产前护理：孕产妇/婴儿和艾滋病毒预防成果的有效性以及与马拉维实施成功相关的背景因素

• 批准号: 10163271
• 负责人: Crystal Lauren Patil
• 金额: $ 62.18万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-22 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163271
• 关键词: AIDS prevention; Address; Adopted; Affect; Africa; Africa South of the Sahara; African; Anemia; Behavior; Blood Pressure; Breast Feeding; Bypass; Caring; Child; Client; Clinic; Clinical Trials Cooperative Group; Consult; Continuity of Patient Care; Country; Data; Distress; Effectiveness; Ensure; Exclusive Breastfeeding; Exposure to; Failure; Family Planning; Female of child bearing age; Government; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Health; Health Policy; Health Priorities; Health Promotion; Health system; Hemorrhage; Hour; Human immunodeficiency virus test; Hybrids; Hypertension; Individual; Infant; Infant Mortality; Intake; Intervention; Knowledge; Late pregnancy; Length; Letters; Life; Link; Low Birth Weight Infant; Malawi; Maternal Mortality; Midwife; Modeling; Monitor; Morbidity - disease rate; Mothers; Neonatal; Neonatal Mortality; Outcome; Perinatal mortality demographics; Play; Policies; Postpartum Period; Pre-Eclampsia; Pregnancy; Premature Birth; Prenatal care; Prevalence; Provider; Psyche structure; Public Health; Quality of Care; Randomized; Randomized Clinical Trials; Research; Resources; Risk; Role; Safe Sex; Savings; Self Assessment; Services; Sex Behavior; Site; Surveys; Tanzania; Testing; Time; Visit; Weight; Woman; antenatal; antenatal care; antiretroviral therapy; burnout; contextual factors; cost; design; effectiveness evaluation; effectiveness testing; effectiveness trial; evidence base; experience; global health; health care service utilization; health record; hybrid type 1 design; implementation process; improved; innovation; mortality; novel; patient oriented; perinatal HIV; premature; primary outcome; satisfaction; scale up; secondary outcome; stillbirth; success; transmission process; treatment as usual; uptake

Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for 2/3 of new HIV infections and 1/4 of preterm births. Antenatal (prenatal) care is the entry point into the health system for many women and offers a unique opportunity to provide life-saving monitoring. However, provider shortages, low quality of care and failure to attend all recommended visits mean that the potential benefits of antenatal care are not realized. There is an urgent need to test novel interventions to reduce health risks for mother and child. Group antenatal care is a transformative model of care that provides a positive pregnancy experience, uses provider time efficiently, and improves perinatal and HIV-related outcomes. Women in group antenatal care have 2-hour visits with the same provider in a group of 8-12 women at a similar stage of pregnancy. Women conduct self-assessments, briefly consult the midwife, and meet for 80-90 minutes of interactive health promotion enlivened by games and role-plays. Women form relationships with midwives and each other. In a US randomized clinical trial (RCT), group care improved prematurity rates, antenatal care attendance, satisfaction with care, breastfeeding practices, safer sex behaviors, and uptake of family planning. Our randomized pilot in Malawi and Tanzania had promising outcomes. More women in group care than in usual care completed ≥4 antenatal visits (94% vs 58%). Their partners were more likely to be tested for HIV during pregnancy (51% vs. 27%). We established that group antenatal care can be offered in a rigorous RCT with high fidelity despite provider shortages. The next step is an adequately powered effectiveness trial. Malawi is an especially appropriate site because it has the world's highest prematurity rate (18%) and high HIV prevalence (10% nationally, 16% at the study site). We use a hybrid design to simultaneously conduct an effectiveness RCT with individual-level randomization and examine implementation processes at 6 clinics in Blantyre District, Malawi. Aim 1 is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that compared to usual care, women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We test Aim 1 hypotheses using multi- level hierarchical models using data from repeated surveys and health records. Aim 2 is to identify clinic-level degree of implementation success and contextual factors associated with success for each clinic and across clinics. Analyses use within and across-case matrices. This high-impact study addresses three global health priorities, maternal and infant mortality and HIV prevention, that affect all women of childbearing age in Malawi. The Ministry of Health strongly supports this project; results will help them decide whether to scale-up this innovative model of group care. Negative results will avoid spending on ineffective care. Positive results will provide evidence needed to adopt group antenatal care nationally and in other low-resource countries.

撒哈拉以南非洲的孕产妇和围产期死亡率最高，占2/3 新的艾滋病毒感染和1/4的早产。产前（产前）护理是卫生系统的切入点 对于许多女性，并提供了提供挽救生命监测的独特机会。但是，提供商 短缺，较低的护理质量和未能参加所有建议的访问意味着 未实现天内护理。迫切需要测试新颖的干预措施，以降低健康风险 母子。小组天内护理是一种变革性的护理模型，可提供阳性妊娠 经验，有效地使用提供者时间，并改善与围产期和HI​​V相关的结果。小组的妇女 在类似的阶段，在一群8-12名妇女中，与同一提供商进行了2小时的访问 怀孕。妇女进行自我评估，短暂咨询助产士，并开会80-90分钟 互动健康促进了游戏和角色扮演。妇女与助产士建立关系 彼此。在美国随机临床试验（RCT）中，小组护理提高了早产率，产前护理 出席，对护理的满意，母乳喂养实践，安全的性行为以及对计划生育的吸收。 我们在马拉维和坦桑尼亚的随机飞行员已承诺结果。在集体护理中的女性比在 通常的护理完成了≥4次触角访问（94％vs 58％）。他们的伴侣更有可能接受艾滋病毒的测试 怀孕期间（51％比27％）。我们确定可以在严格的RCT中提供小组的天前护理 高保真目的地提供者短缺。下一步是一项足够的有效性试验。 马拉维是一个特别合适的地点，因为它具有世界上最高的早产率（18％）和高艾滋病毒 患病率（全国10％，研究地点为16％）。我们使用混合设计简单地进行 在6个诊所的个人水平随机化和检查实施过程中的有效性RCT 马拉维的布兰蒂尔区。目的1是在6个月内评估组触角护理的有效性 产后。我们假设与通常的护理相比，小组护理中的妇女及其婴儿的妇女的妇女将少 发病率和死亡率以及更积极的HIV预防结果。我们使用多种多样测试目标1 使用重复调查和健康记录中的数据级别分层模型。目标2是识别诊所级别 实施程度的成功和与每个诊所成功相关的背景因素 诊所。分析内部和跨案例材料的使用。这项高影响力的研究解决了三个全球健康 优先事项，即影响马拉维育龄妇女的母亲和婴儿预防。 卫生部强烈支持该项目；结果将帮助他们决定是否扩展 团体护理的创新模型。负面结果将避免在无效护理上支出。积极的结果将会 提供在全国和其他低资源国家采用群体抗原护理所需的证据。