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.

撒哈拉以南非洲地区孕产妇和围产儿死亡率全球最高，占全球孕产妇死亡率的 2/3 新发艾滋病毒感染和 1/4 的早产是进入卫生系统的切入点。 对许多妇女来说，并提供了提供挽救生命监测的独特机会。 短缺、护理质量低下以及未能参加所有建议的就诊意味着 产前护理尚未实现，迫切需要测试新的干预措施以降低健康风险。 母亲和孩子的团体产前护理是一种变革性的护理模式，可以提供积极的怀孕。 经验，有效利用提供者的时间，并改善围产期和艾滋病毒相关的结果。 产前护理对 8 至 12 名处于相似产程阶段的妇女进行 2 小时的访问，由同一提供者提供 妇女进行自我评估，简要咨询助产士，并进行 80-90 分钟的会面。 通过游戏和角色扮演促进互动健康促进妇女与助产士建立关系。 在美国的一项随机临床试验 (RCT) 中，团体护理可以改善早产率、产前护理。 出勤率、护理满意度、母乳喂养习惯、安全性行为以及计划生育的接受度。 我们在马拉维和坦桑尼亚进行的随机试验取得了有希望的结果，接受团体护理的女性人数多于接受团体护理的女性人数。 完成≥4次产前检查的常规护理（94% vs 58%） 他们的伴侣更有可能接受艾滋病毒检测。 怀孕期间（51% vs. 27%）我们确定可以通过严格的随机对照试验提供团体产前护理。 尽管供应商短缺，但仍具有高保真度。下一步是进行充分供电的有效性试验。 马拉维是一个特别合适的地点，因为它拥有世界上最高的早产率（18%）和高艾滋病毒感染率 患病率（全国为 10%，研究地点为 16%）我们使用混合设计来同时进行一项研究。 具有个体水平随机化的有效性随机对照试验，并检查 6 个诊所的实施过程 马拉维布兰太尔区 目标 1 是评估 6 个月内团体产前护理的有效性。 我们认为，与常规护理相比，团体护理中的女性及其婴儿的产后情况会更少。 我们使用多种方法测试目标 1 假设。 使用重复调查和健康记录的数据建立层次模型，目标 2 是确定诊所级别。 实施成功的程度以及与每个诊所和跨诊所成功相关的背景因素 这项具有高影响力的研究针对三个全球健康问题进行了分析。 影响马拉维所有育龄妇女的优先事项、孕产妇和婴儿死亡率以及艾滋病毒预防。 卫生部大力支持该项目；结果将帮助他们决定是否扩大该项目； 集体护理的创新模式。 积极的结果将避免花费在无效的护理上。 提供在国家和其他资源匮乏国家采用团体产前护理所需的证据。