Implementing Comprehensive PMTCT and HIV Prevention for South African Couples

为南非夫妇实施全面的预防母婴传播和艾滋病毒预防

基本信息

批准号：
8657677
负责人：
Deborah Lynne Jones
金额：
$ 52.16万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-29 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8657677
关键词：
AIDS prevention Address Adherence Adoption African Age-Months Barrier Contraception Behavior Therapy Behavioral Breast Feeding Caring Child Clinic Clinical Communication Community Health Centers Conceptions Country Couples Decision Making Disclosure Effectiveness of Interventions Enrollment Ensure Epidemic Family Family Planning Goals Guidelines HIV HIV Infections HIV Seropositivity Health Health Policy Human immunodeficiency virus test Incidence Individual Infant Infant Care Intention Intervention Knowledge Laboratories Measures Mothers National Institute of Allergy and Infectious Disease Nature Newborn Infant Outcome Participant Pharmaceutical Preparations Phase Pilot Projects Population Postpartum Period Pregnancy Pregnant Women Prevalence Prevention Process Protocols documentation Province Public Health Randomized Recruitment Activity Risk Risk Reduction Rural Rural Community Services South Africa Testing Treatment Protocols Vertical Disease Transmission Vulnerable Populations Wife Woman arm base cohort design effective therapy evidence base falls feeding improved intimate partner violence male medication compliance men policy implication postnatal pregnant prevent programs public health relevance reproductive safer sex scale up sex risk social social stigma transmission process uptake

项目摘要

DESCRIPTION (provided by applicant): In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available "prevention of mother-to-child transmission" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be "necessary, but not sufficient" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the "Vikela Umndeni: Protect Your Family" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.

描述（由申请人提供）：2010 年，在南非农村地区，只有三分之二在社区卫生中心寻求产前护理的 HIV 阳性孕妇充分利用了现有的“预防母婴传播”(PMTCT) 服务 (SADOH) ）。虽然鼓励男性伴侣的参与作为增加预防母婴传播的潜在手段，但男性却不愿意陪伴妻子/伴侣进行产前护理。最近的研究普遍支持男性参与促进预防母婴传播，但这种参与的性质和影响尚不清楚且未经检验。同样明显的是，耻辱、披露和亲密伴侣暴力等因素对预防母婴传播的采用和保留在护理中构成了重大障碍，这表明男性的参与对于实现世界卫生组织婴儿艾滋病毒感染率<5%的目标可能是“必要的，但还不够”发生率。可能需要采取额外措施来增加艾滋病毒阳性孕妇参与预防母婴传播的程度。 2011年，普马兰加省的艾滋病毒感染率全国最高（36.7%），农村诊所的婴儿艾滋病毒感染率高达50%。该省的预防母婴传播率是南非最低的（69%）。本申请提议扩大一项在普马兰加省成功实施的 PEPFAR 支持的 PMTCT 夫妇干预试点研究（“Vikela Umndeni：保护您的家庭”），以纳入更具代表性的 HIV 阳性孕妇及其伴侣群体，这是主要目标旨在确定男性伴侣的参与加上行为干预是否会通过提高产前和产后期间对 ARV/PMTCT 方案（包括母乳喂养和计划生育）的遵守程度来显着降低婴儿艾滋病毒发病率。拟议的研究将招募两组从 12 个随机分配的社区卫生中心招募的 HIV 阳性孕妇（6 个实验中心，6 个对照）：a) 没有男性伴侣参加的妇女 (n = 720)，其次是 b) 与男性伴侣一起参加的妇女男性伴侣（n = 720对夫妇），以确定男性参与本身的影响或与行为预防母婴传播干预相结合是否可以显着减少婴儿产前、围产期和产后的艾滋病毒感染。这是我们的打算通过让妇女和夫妇参与独特的、受控的、六次产前和产后风险降低/预防母婴传播促进干预措施，解决障碍，将普马兰加省预防母婴传播的参与率从目前的水平 (69%) 大幅提高到 90-95%预防母婴传播（例如，耻辱、披露、亲密伴侣暴力、沟通、婴儿喂养方法、更安全受孕），阻碍妇女和男子充分利用为其及其婴儿提供的治疗机会。根据我们的试点研究令人鼓舞的初步结果，CHC 成功采用“Vikela Umndeni：保护您的家人”计划可能会对控制南非农村最脆弱人群中的流行病产生重大公共卫生政策影响：艾滋病毒+孕妇和他们的婴儿。