Efficacy of HIV Posttest Support for ANC in South Africa

南非 ANC 艾滋病毒检测后支持的功效

• 批准号: 7163973
• 负责人: Suzanne Maman
• 金额: $ 38.8万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7163973
• 关键词: AIDS /HIV diagnosis; AIDS /HIV test; AIDS education /prevention; Africa; antiviral agents; behavior modification; behavioral /social science research tag; breast feeding; clinical research; communicable disease transmission; counseling; early /brief intervention /therapy; educational resource design /development; governmental health /scientific organization; high risk behavior /lifestyle; infant human (0-1 year); outcomes research; postpartum; prenatal care; prenatal diagnosis; psychosocial service; sex partner; sexually transmitted diseases; social support network; videotape /videodisc; women' s health

DESCRIPTION (provided by applicant): This is a randomized controlled trial to examine the efficacy of an integrated model of HIV post-test support for women attending the King Edward VIII Hospital (KEH) antenatal care (ANC) clinic in Durban, South Africa. The rates of HIV infection among pregnant women in South Africa are among the highest in the world. The government provides all women with access to antiretrovirals (ARV) during pregnancy to reduce transmission of HIV infection to infants. However, there is a growing recognition that the uptake and adherence to PMTCT programs could be improved and that the current programs largely overlook the enormous psychosocial challenges associated with testing pregnant women. The proposed intervention is designed to tailor VCT for the ANC setting and provide a continuum of psychosocial support through: (1) a health education video before HIV pre-test counseling; (2) HIV pre- and post-test counseling that prepares women for decisions related to HIV testing, HIV serostatus disclosure, infant feeding and ARV prophylaxis; (3) two additional post-test counseling sessions which coincide with 6 and 10-week postpartum visits and focus on infant health, sexual risk reduction, partner testing, and family planning and; (4) an active referral system to support groups run by an NGO affiliated with KEH. To accomplish this trial we will: (1) conduct ethnographic research to describe the determinants of key behaviors from the perspective of women and their male partners; (2) enroll and interview a cohort of 1,495 HIV-positive and HIV-negative participants to determine baseline biologic (Gonorrhea, Trichomonas vaginalis, Chlamydia), behavioral, and psychosocial characteristics; (3) randomize participants to standard VCT or standard VCT plus post-test support; (4) Follow participants 9-months post-partum to compare sexual risk (STI incidence, correct & consistent condom use, partner testing); factors associated with HIV mother to child transmission (acceptance of VCT and ARVs, infant feeding choices, family planning intention) and psychosocial outcomes (social support, emotional distress and partner violence) among participants who receive the VCT plus post-test support with participants who receive standard VCT. We hypothesize that the intervention will have a public health impact by expanding the preventive benefits of PMTCT programs while concurrently increasing the benefits and minimizing the psychosocial harms associated with VCT and HIV serostatus disclosure for women.

描述（由申请人提供）：这是一项随机对照试验，旨在检查艾滋病毒后测试后支持的综合模型对参加南非德班的爱德华八世医院（KEH）产前护理（ANC）诊所的妇女的疗效。南非孕妇的艾滋病毒感染率是世界上最高的。政府在怀孕期间为所有妇女提供抗逆转录病毒（ARV）的机会，以减少艾滋病毒感染向婴儿的传播。但是，人们越来越认识到可以改善对PMTCT计划的吸收和遵守，并且当前的计划在很大程度上忽略了与测试孕妇有关的巨大社会心理挑战。拟议的干预措施旨在为ANC设置量身定制VCT，并通过：（1）在HIV预测试前咨询之前提供健康教育视频； （2）艾滋病毒预测试前和测试后咨询，使妇女做好与艾滋病毒测试，艾滋病毒血清披露，婴儿喂养和ARV预防有关的决定； （3）另外两次测试后咨询会议与6周和10周的产后访问一致，并专注于婴儿健康，减少性风险，伴侣测试和计划生育以及； （4）一个主动推荐系统支持由KEH隶属的非政府组织运行的组。为了完成这项试验，我们将：（1）从妇女及其男性伴侣的角度进行民族志研究来描述关键行为的决定因素； （2）注册和访谈1,495名HIV阳性和HIV阴性参与者的队列，以确定基线生物学（淋病，trichomonas阴道，衣原体），行为和心理社会特征； （3）将参与者随机为标准VCT或标准VCT加后测试后支持； （4）跟随参与者9个月后的产后比较性风险（STI发病率，正确和一致的安全套使用，合作伙伴测试）；在接受VCT加上与获得标准VCT的参与者的参与者的参与者支持的参与者中，与艾滋病毒母亲与儿童传播有关的因素（接受VCT和ARV，婴儿喂养选择，计划生育意图）和社会心理成果（社会支持，情绪困扰和伴侣暴力）相关的因素。我们假设该干预措施将通过扩大PMTCT计划的预防效益，同时增加收益并最大程度地减少与VCT和HIV Serostatus对妇女披露相关的社会心理伤害，从而产生公共卫生的影响。