Asha Improving Health and Nutrition of Indian Women with AIDS and Their Children

阿莎改善印度艾滋病妇女及其子女的健康和营养

• 批准号: 8467393
• 负责人: Maria L. Ekstrand
• 金额: $ 62.75万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-23 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8467393
• 关键词: 8 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anthropometry; Biolectric Impedance; Biological Markers; Body Composition; Car Phone; Caring; Child; Child Care; Cholesterol; Clinical Trials Design; Collaborations; Communities; Computers; Consumption; Data; Data Collection; Development; Diet; Disease Progression; Environment; Face; Family member; Fatty acid glycerol esters; Federal Government; Focus Groups; Food; Food Supplementation; Food Supplements; Funding; Grant; Growth; Growth and Development function; HIV; HIV Seropositivity; Health; Immune; India; Infant; Intake; Intervention; Life; Light; Lipids; Longitudinal Studies; Macronutrients Nutrition; Malnutrition; Measures; Mental Health; Methodology; Methods; Minerals; Mission; Modeling; Monitor; Mothers; Muscle; National Institute of Mental Health; Nutrition Assessment; Nutritional; Nutritional Support; Outcome; Pilot Projects; Pregnant Women; Proteins; Published Comment; Publishing; Recommendation; Relative (related person); Research; Research Personnel; Risk; Rural; Rural Health; Rural Population; Science; Social Work; Supplementation; Technology; Testing; Time; Training; Treatment Protocols; Triglycerides; Underweight; Vitamins; Weight Gain; Wireless Technology; Woman; Women Status; Work; aged; antiretroviral therapy; arm; base; coping; depressive symptoms; design; experience; follow-up; improved; indexing; intervention program; meetings; muscle form; novel; nutrition; nutrition education; physical conditioning; post intervention; primary outcome; programs; public health relevance; scale up; social stigma; therapy adherence; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): Rural women living with AIDS (WLA) in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. Furthermore, they are generally underweight and malnourished, with adherence to antiretroviral therapy (ART) at levels lower than 50%. While the Indian Government's National Rural Health Mission utilizes a successful model to address the health needs of the rural population by training village women as Ashas (Accredited Social Work Activists) to enhance health of pregnant women and their infants, the focus on rural WLA needs to be significantly strengthened. U.S. and Indian collaborators recently completed an R34 pilot study which has demonstrated successful improvement in ART adherence, CD4 levels, and physical and mental health among rural Indian WLA. In total, 34 rural intervention WLA were supported by grant-trained, HIV-focused Ashas who provided assistance to WLA in decreasing barriers to ART adherence and provided protein supplementation compared to equal numbers of usual care WLA who received minimal protein supplementation. While very successful, our Asha pilot study monitored only WLA, despite the fact that many rural children are also at risk for delayed physical growth and psychomotor development. More importantly, we were not able to separate the nutritional component from the care and support component of the Asha, did not incorporate nutritional biomarkers, and were limited by only a six-month follow-up. In light of the mandate to advance both the science of nutrition and sustainability in real settings, our experienced team proposes to build on and extend our successful pilot work to meet this need, by assessing the incremental advantages of nutritional support to Asha care and support alone, and the impact of these programs on an index child (oldest between 3-8 years). In addition, we will take advantage of rural India's excellent mobile phone coverage and computer technology for both wireless data collection and data transfer. The proposed longitudinal study will use a 2x2 factorial design, specifically, 1) Asha support alone for WLA , vs. 2) Asha support for WLA + nutrition (food-based) training, vs. 3) Asha support for WLA + food supplementation, vs. 4) Asha support for WLA + nutrition training + food supplementation, to test the effects of nutrition training and/or food supplementation on primary outcomes of anthropometric parameters and immune status (CD4 levels) of the WLA at 6-, 12- and 18-month follow-up; and secondarily on ART adherence, psychological health, nutritional adequacy and lipid status of the WLA over time. Based upon reviewers' comments, among index children, we streamlined our assessments to include anthropometric parameters and psychomotor development; and among those HIV positive, immune status.

描述（由申请人提供）：印度农村感染艾滋病的妇女 (WLA) 在获得和遵循治疗方案、照顾家庭成员以及保持积极的心理健康方面继续面临严峻的挑战。此外，他们普遍体重不足且营养不良，抗逆转录病毒治疗 (ART) 的依从率低于 50%。虽然印度政府的国家农村卫生任务利用成功的模式来解决农村人口的健康需求，将乡村妇女培训为 Ashas（认可的社会工作活动家），以增强孕妇及其婴儿的健康，但对农村 WLA 的关注需要得到显着加强。美国和印度合作者最近完成了一项 R34 试点研究，该研究证明印度 WLA 农村地区的 ART 依从性、CD4 水平以及身心健康得到了成功改善。总共有 34 个农村干预 WLA 得到了受过赠款培训、专注于艾滋病毒的 Asha 的支持，他们向 WLA 提供帮助，减少 ART 依从性的障碍，并提供蛋白质补充，而同等数量的常规护理 WLA 则接受最低限度的蛋白质补充。我们的 Asha 试点研究虽然非常成功，但仅监测 WLA，尽管事实上许多农村儿童也面临身体生长和精神运动发育迟缓的风险。更重要的是，我们无法将 Asha 的营养成分与护理和支持成分分开，没有纳入营养生物标志物，并且仅限于六个月的随访。鉴于在实际环境中推进营养科学和可持续发展的任务，我们经验丰富的团队建议通过评估营养支持对阿莎护理和支持的增量优势，在我们成功的试点工作的基础上进行扩展并扩展，以满足这一需求，以及这些计划对指标儿童（最大的 3-8 岁）的影响。此外，我们将利用印度农村地区良好的移动电话覆盖和计算机技术进行无线数据收集和数据传输。拟议的纵向研究将使用 2x2 因子设计，具体来说，1) Asha 仅支持 WLA，对比 2) Asha 支持 WLA + 营养（基于食物的）培训，对比 3) Asha 支持 WLA + 食物补充剂， vs. 4) Asha 支持 WLA + 营养训练 + 食物补充，以测试营养训练和/或食物补充对人体测量参数和免疫状态（CD4 水平）主要结果的影响6、12 和 18 个月随访时的 WLA；其次是随时间推移的 ART 依从性、心理健康、营养充足性和 WLA 的血脂状况。根据审稿人的评论，在指标儿童中，我们简化了评估，包括人体测量参数和精神运动发育；在那些艾滋病毒呈阳性的人中，还有免疫状况。