Developing an enhanced Mentor Mother strategy to improve prevention of mother-to-child transmission of HIV (PMTCT) outcomes

制定强化的导师母亲战略，以改善艾滋病毒母婴传播 (PMTCT) 的预防结果

• 批准号: 10481028
• 负责人: JAMES G CARLUCCI
• 金额: $ 15.6万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10481028
• 关键词: Acquired Immunodeficiency Syndrome; Address; Advocate; Affect; Africa South of the Sahara; Age-Months; Caring; Cessation of life; Child; Clinic; Data; Development; Diagnostic; Educational workshop; Effectiveness; Event; Funding; Future; Goals; HIV; HIV Infections; Health; Human immunodeficiency virus test; Hybrids; Infant; Intervention; Interview; Kenya; Knowledge; Lactation; Leadership; Maternal and Child Health; Mentors; Mentorship; Meta-Analysis; Methods; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; Mothers; Outcome; Outcome Measure; Perception; Physicians; Prevention; Productivity; Randomized Clinical Trials; Research; Research Infrastructure; Research Methodology; Research Personnel; Resource-limited setting; Scientist; Services; Targeted Research; Testing; Vertical Disease Transmission; Viral; Viremia; Woman; Wool; career development; design; effectiveness implementation study; experience; follow-up; health care availability; implementation fidelity; implementation science; improved; low and middle-income countries; mortality; peer; person centered; pregnant; prevent; programs; research and development; risk minimization

Prevention of mother-to-child transmission of HIV (PMTCT) programs offer a range of services to women living with HIV (WLHIV) to maintain their health and minimize the risk of their HIV-exposed infants (HEI) acquiring HIV. Despite widespread implementation of PMTCT services in sub-Saharan Africa, only two-thirds of WLHIV are virally suppressed, and nearly 40% of HEI are lost to follow-up or die by 18 months of age. There is a critical need to develop person-centered strategies targeting the factors preventing WLHIV and their HEI from realizing the full benefits of PMTCT care. Mentor Mothers (MM) are peer advocates who support WLHIV and HEI to promote improved PMTCT outcomes. While MM show promise in this regard, it is clear a “one size fits all” approach lacks responsiveness to the fact that some WLHIV and HEI need minimal support while others have specific needs. Research is needed to understand what strategies MM can use to address factors known to influence PMTCT outcomes, and how best to implement these strategies with high-fidelity in real-world settings. This proposal aims to address knowledge gaps and promote optimal PMTCT outcomes through person-centered development of an enhanced MM strategy that focuses on both the specific problems faced by WLHIV and HEI, as well as the real-world constraints of PMTCT programs. The central hypothesis is that this enhanced MM strategy can be implemented with high acceptability and fidelity, resulting in improved PMTCT outcomes. We will test this hypothesis through research targeted to the following Specific Aims. AIM 1: Use a participatory research approach to develop an enhanced MM strategy. In Sub-Aim 1a we will perform qualitative interviews with MM and WLHIV (both those with and without unfavorable PMTCT outcomes [attrition, viremia, or vertical transmission]) to identify: (i) feasible enhancements to the current MM strategy, (ii) barriers to optimizing the MM strategy, and (iii) approaches to overcoming these barriers. In Sub-Aim 1b we will conduct participatory design workshops with key implementation stakeholders (MM, PMTCT program leadership, and clinic staff) to develop an enhanced MM strategy with optimal potential for sustainable implementation. AIM 2: Conduct a pilot hybrid type 3 implementation-effectiveness study of the enhanced MM strategy. The enhanced MM strategy will be implemented at one clinic. We will use a mixed-methods approach to thoroughly assess acceptability, feasibility, and fidelity to the enhanced MM strategy. A pre-post assessment of key PMTCT outcome measures will provide preliminary effectiveness data. We expect this K23 proposal to advance my expertise in HIV implementation science, qualitative and mixed-methods research, and person- centered participatory design while also generating the compelling preliminary data needed to support a future R01 application for a pragmatic cluster randomized clinical trial of the enhanced MM strategy. These K23 research and career development activities will culminate in my transition to independence as an R01-funded, physician-scientist.

预防母亲到儿童艾滋病毒（PMTCT）计划为居住的妇女提供一系列服务 与艾滋病毒（WLHIV）保持健康并最大程度地减少其艾滋病毒暴露婴儿（HEI）的风险 艾滋病病毒。尽管在撒哈拉以南非洲实施了PMTCT服务的广泛性，但只有三分之二的WLHIV 几乎被抑制了，几乎40％的HEI失去了随访或死亡18个月大。有一个 制定以人为本策略的批判性需要，以防止WLHIV及其HEI的因素 意识到PMTCT护理的全部好处。导师母亲（MM）是支持WLHIV和的同伴倡导者 HEI促进改善PMTCT结果。虽然MM在这方面表现出承诺，但很明显“一个尺寸适合 所有“方法都缺乏对某些WLHIV和HEI需要最小支持的事实的反应 有特定的需求。需要研究以了解MM可以使用哪些策略来解决已知因素 影响PMTCT的结果，以及如何在现实世界中以高保真性实施这些策略 设置。该建议旨在解决知识差距并通过 以人为本的增强MM策略的发展，该策略侧重于两个面临的特定问题 WLHIV和HEI以及PMTCT计划的现实限制。中心假设是 这种增强的MM策略可以以高的可接受性和忠诚来实施，从而改善 PMTCT结果。我们将通过针对以下特定目标的研究来检验这一假设。目标1： 使用参与研究方法来制定增强的MM策略。在Sub-aim 1a中，我们将表演 与MM和WLHIV的定性访谈（既有和没有PMTCT结果的人 [损耗，病毒血症或垂直传播]）识别：（i）当前MM策略的可行增强，（ii） 优化MM策略的障碍，以及（iii）克服这些障碍的方法。在Sub-aim 1B中 将通过关键实施利益相关者（MM，PMTCT计划）进行参与设计研讨会 领导力和诊所工作人员）制定增强的MM战略，具有最佳的可持续性潜力 执行。 AIM 2：进行增强的MM的Pilot Hybrid Hybrid 3型实施效应研究 战略。增强的MM策略将在一个诊所实施。我们将使用混合方法 彻底评估对增强的MM策略的可接受性，可行性和保真度。前评估 关键PMTCT结果指标将提供初步的有效性数据。我们希望这个K23提案能 提高我在HIV实施科学，定性和混合方法研究以及人物方面的专业知识 集中参与设计，同时还产生支持未来所需的引人注目的初步数据 R01应用于增强的MM策略的务实群集随机临床试验。这些K23 研究和职业发展活动将在我向独立的过渡中最终达到R01资助， 医师科学家。