A Structural Intervention To Integrate Reproductive Health Into HIV Care

将生殖健康纳入艾滋病毒护理的结构性干预措施

基本信息

批准号：
8037580
负责人：
Joanne Ellen Mantell
金额：
$ 18.85万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-03-01 至 2013-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8037580
关键词：
Accounting Acquired Immunodeficiency Syndrome Address African Algorithms Attitude Behavior Belief Biological Caring Child Cities Client Clinic Conceptions Consensus Contraceptive Agents Contraceptive methods Counseling Country Data Decision Making Developing Countries Development Diagnosis Economics Ensure Environment Epidemic Failure Family Planning Family Planning Personnel Family Practice Female Condoms Fertility Goals Guidelines HIV HIV Infections HIV Seropositivity HIV diagnosis HIV prevention trial HIV/STD Health Health Policy Heterogeneity Individual Infant Infection International Intervention Interview Lead Life Male Condoms Measures Medical Modeling Morbidity - disease rate NIH Office of AIDS Research Outcome Outcome Assessment Parenting behavior Persons Phase Phase II Clinical Trials Policies Policy Analysis Political Factor Positioning Attribute Pregnancy Prenatal care Prevention Process Professional counselor Protocols documentation Provider Public Health Public Health Schools Public Sector Randomized Controlled Trials Recommendation Reproductive Health Reproductive Health Services Reproductive History Research Research Design Research Infrastructure Research Personnel Resources Risk Risk Reduction Safety Services Severities Sexual Health Site South Africa Staff Attitudes Stigmata Testing Time Translations Treatment Efficacy Universities Unsafe Sex Vertical Disease Transmission Weight Woman Work base care systems child bearing clinical care condoms cost cost effective cultural values experience follow-up indium arsenide informant innovation men metropolitan mortality pregnancy prevention pregnant pressure prevent primary outcome safer sex social social stigma standard of care success therapy design tool unintended pregnancy

Accounting Acquired Immunodeficiency Syndrome Address African Algorithms Attitude Behavior Belief Biological Caring Child Cities Client Clinic Conceptions Consensus Contraceptive Agents Contraceptive methods Counseling Country Data Decision Making Developing Countries Development Diagnosis Economics Ensure Environment Epidemic Failure Family Planning Family Planning Personnel Family Practice Female Condoms Fertility Goals Guidelines HIV HIV Infections HIV Seropositivity HIV diagnosis HIV prevention trial HIV/STD Health Health Policy Heterogeneity Individual Infant Infection International Intervention Interview Lead Life Male Condoms Measures Medical Modeling Morbidity - disease rate NIH Office of AIDS Research Outcome Outcome Assessment Parenting behavior Persons Phase Phase II Clinical Trials Policies Policy Analysis Political Factor Positioning Attribute Pregnancy Prenatal care Prevention Process Professional counselor Protocols documentation Provider Public Health Public Health Schools Public Sector Randomized Controlled Trials Recommendation Reproductive Health Reproductive Health Services Reproductive History Research Research Design Research Infrastructure Research Personnel Resources Risk Risk Reduction Safety Services Severities Sexual Health Site South Africa Staff Attitudes Stigmata Testing Time Translations Treatment Efficacy Universities Unsafe Sex Vertical Disease Transmission Weight Woman Work base care systems child bearing clinical care condoms cost cost effective cultural values experience follow-up indium arsenide informant innovation men metropolitan mortality pregnancy prevention pregnant pressure prevent primary outcome safer sex social social stigma standard of care success therapy design tool unintended pregnancy

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项目摘要

DESCRIPTION (provided by applicant): In South Africa, neither general medical nor HIV-specific treatment practices routinely address issues of discordant/untested partners or the concurrent HIV protection needs and fertility goals of those who are HIV+. Women infected with HIV have insufficient information about contraception and parenting options, and these needs are inadequately addressed among HIV+ men. Regardless of societal or personal attitudes about the soundness of HIV-positive persons seeking conception, our pilot data from two Cape Town clinics show that nearly 50% of recently diagnosed HIV-positive women and men accessing HIV care for the first time are seeking or desirous of having children in the next year. A multi-level structural intervention that simultaneously addresses stigma and poor access to contraceptive services and introduces best-practices counseling approaches that maximize sexual risk reduction based on clients' personal situations is urgently needed. In the proposed study, we will (1) conduct formative research with key stakeholders to inform the development of a multi-level structural intervention to integrate sexual and reproductive health services into HIV clinical care; (2) develop a standardized counseling algorithm and decision-making tool that tailors safer sex, contraception, and fertility messages to HIV+ individuals' circumstances; and (3) develop, implement, and evaluate the efficacy of a proof-of-concept, multi-level structural intervention that integrates reproductive health services into HIV care for HIV+ women and men. The primary outcome at the level of Clinics will be a comparison of changes in the clinic environment and staff attitudes and behaviors regarding the reproductive health of HIV+ persons as perceived by both staff and clients. The primary outcome at the level of Clients among those who wish to avoid childbearing is success in achieving this aim as measured by an algorithm we will develop that will allow us to establish a binary outcome that accounts for the heterogeneity of situations and goals. Among clients who are open to the possibility of childbearing, the "appropriate" outcome will be determined based on a consensus process. Ensuring access to effective contraception, including condoms, is potentially cost-effective as it could reduce unintended pregnancies and maternal morbidity and mortality as well as avert HIV infections in partners and infants at a lower cost than caring for an infected person. If our proof-of-concept (Phase II) trial suggests efficacy, the intervention has the potential for being readily incorporated into the Cape Town metropolitan public health infrastructure and HIV care systems in other countries with emerging AIDS epidemics.

描述（由申请人提供）：在南非，普通医学和特定艾滋病毒的治疗实践常规解决了不一致/未经测试的伴侣的问题，或者同时解决HIV+的艾滋病毒保护需求和生育目标。感染了艾滋病毒的妇女没有足够的有关避孕和育儿选择的信息，在艾滋病毒+男性中，这些需求不足以满足。无论对寻求概念的艾滋病毒阳性人的合理性的社会或个人态度如何，我们来自两个开普敦诊所的飞行员数据表明，近50％的最近被诊断出的最近被诊断出的HIV阳性男性和男性首次寻求或渴望在明年寻求孩子。迫切需要一项多层结构干预，同时解决避孕服务的污名和不良的机会，并引入最佳实践咨询方法，从而迫切需要根据客户的个人情况最大化性风险的最大化。在拟议的研究中，我们将（1）与主要利益相关者进行形成性研究，以告知多层结构干预措施的发展，以将性和生殖卫生服务整合到HIV临床护理中；（2）开发一种标准化的咨询算法和决策工具，该工具为艾滋病毒+个人的情况量身定制更安全的性，避孕和生育信息；（3）开发，实施和评估概念验证，多级结构干预的功效，该干预措施将生殖卫生服务纳入HIV+男性和男性的HIV护理中。诊所级别的主要结果将是对诊所环境的变化以及员工和客户所感知的艾滋病毒+人的生殖健康的态度和行为的比较。希望避免生育的人中客户级别的主要结果是成功地实现了通过算法衡量的目标，我们将开发，这将使我们能够建立一个二进制结果，以说明情况和目标的异质性。在愿意育有生育可能性的客户中，将根据共识过程确定“适当的”结果。确保获得有效的避孕药（包括避孕套）具有可能具有成本效益的可能性，因为它可以减少意外怀孕，产妇的发病率和死亡率，以及伴侣和婴儿中的艾滋病毒感染，其成本低于照顾感染者。如果我们的概念验证（第二阶段）试验提出了功效，那么干预措施有可能被纳入开普敦大都市公共卫生基础设施和艾滋病毒护理系统中的其他国家 /地区的艾滋病护理系统。