Integrating HIV with Innovative Group Antenatal Care in Two African Countries

在两个非洲国家将艾滋病毒与创新的团体产前护理相结合

基本信息

批准号：
8736012
负责人：
Crystal Lauren Patil
金额：
$ 12.88万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
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：
2013-09-18 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8736012
关键词：
AIDS prevention Accounting Address Adherence Adult Africa Africa South of the Sahara African Attention Awareness Behavioral Birth Caring Client Clinic Clinical Trials Cognitive Community Health Continuity of Patient Care Counseling Country Couples Data Development Early treatment Education Evaluation Exercise Future Goals HIV HIV Infections HIV Seropositivity Health Health Priorities Health care facility Health education Health system Healthcare Heterosexuals High Prevalence Hour Human immunodeficiency virus test Individual Infant Infection Information Services Institutes Intervention Interview Knowledge Learning Link Malawi Mediation Modeling Outcome Outcome Measure Policy Maker Pre-Post Tests Pregnancy Pregnant Women Premature Birth Prevalence Prevention Prevention education Primary Prevention Procedures Process Provider Quality of Care Randomized Reporting Research Research Personnel Resources Rural Schedule Self Efficacy Services Site Tanzania Testing Time Training Vertical Disease Transmission Visit Woman Work base behavior change community based participatory research condoms efficacy testing evidence base follow-up forging global health health knowledge improved innovation meetings men public health relevance randomized trial safer sex satisfaction skills success transmission process

项目摘要

DESCRIPTION (provided by applicant): Reducing new HIV infections is a global health priority, especially in sub-Saharan Africa, where 70% of new HIV infections and 75% of vertical infections occur. Due to shortages in health workers and other resources, significant coverage gaps exist in initial HIV testing of pregnant women at antenatal care (ANC) and referrals of those who are HIV-positive for prevention of mother-to-child transmission (PMTCT) and treatment. Furthermore, almost no attention is given to the prevention needs of HIV-negative pregnant women at ANC. As a result, researchers and policy makers have called for innovative approaches to reconceptualize the ANC- HIV-PMTCT care continuums. The proposed R21 will be the first adaptation of the CenteringPregnancy (CP) group ANC care model in low-resource, high HIV prevalence settings. The shift to group care is an innovative paradigm that makes more efficient use of scare health practitioner time and improves quality of care by incorporating essential HIV-related information and services into ANC for all women, regardless of HIV status. In CP-Africa, a group of 12 mixed status (HIV positive and negative) women with similar due dates meet with the same trained practitioner at every ANC visit. Self and practitioner assessments and practitioner-initiated linkages to others services (e.g., PMTCT) occur in the first 30 minutes. This is followed by 90 minutes of education and skill-building to promote awareness of HIV testing, prevention, and treatment options and build self-efficacy leading to behavioral changes and increased health system use. Continuity of care will strengthen linkages to HIV-related and other services as women forge a collaborative relationship with a specific practitioner. Couples testing is promoted by inviting men to an HIV session followed by a testing opportunity. This R21 will be used to complete essential developmental work that will enable us to bring this paradigm- changing model to sub-Saharan Africa and allow us to move toward testing the efficacy of CP-Africa on a large scale. Guided by principles of community-based participatory research, we will develop and pilot CP-Africa in Malawi and Tanzania, countries with different HIV prevalence (11% vs. 6%), HIV testing rates, and PMTCT coverage. ANC sessions and activities, procedures to schedule practitioner time, meeting space, form groups and facilitate follow-up on individual women's HIV, PMTCT, and other needed services will be developed collaboratively with stakeholders. Outcome measures new to sub-Saharan Africa will be validated by cognitive interviewing. We will then pilot the entire CP-Africa package at 4 sites with 192 women randomized into CP- Africa or individualized care; obtain baseline, late pregnancy and 8 week post birth outcome data; and conduct full process evaluations of the implementation process including direct observation of sessions and qualitative assessments by women and providers. Data from this study will be collated and used to refine the CP-Africa package to prepare for a clinical trial. If CP-Africa can be successfully adapted in two African countries, this will enhance the likelihood of success in other low-resource settings.

描述（由申请人提供）：减少艾滋病毒新发感染是全球卫生的首要任务，特别是在撒哈拉以南非洲地区，那里有 70% 的艾滋病毒新发感染和 75% 的垂直感染发生。由于卫生工作者和其他资源的短缺，在产前护理 (ANC) 中对孕妇进行初始艾滋病毒检测以及将艾滋病毒呈阳性者转诊预防母婴传播 (PMTCT) 和治疗方面存在巨大的覆盖范围差距。此外，ANC 几乎没有关注艾滋病毒阴性孕妇的预防需求。因此，研究人员和政策制定者呼吁采用创新方法来重新概念化 ANC-HIV-PMTCT 护理连续体。拟议的 R21 将是 CenteringPregnancy (CP) 团体 ANC 护理模式在资源匮乏、艾滋病毒高流行地区的首次改编。向团体护理的转变是一种创新范式，通过将基本的艾滋病毒相关信息和服务纳入 ANC 中，为所有女性（无论艾滋病毒状况如何），更有效地利用医疗保健人员的宝贵时间并提高护理质量。在 CP-Africa，一组由 12 名混合状况（HIV 阳性和阴性）且预产期相似的女性在每次 ANC 就诊时都会与同一位经过培训的医生会面。自我和从业者评估以及从业者发起的与其他服务（例如预防母婴传播）的联系发生在前 30 分钟内。接下来是 90 分钟的教育和技能培养，以提高对艾滋病毒检测、预防和治疗方案的认识，并建立自我效能，从而导致行为改变和增加卫生系统的使用。随着妇女与特定从业者建立合作关系，连续性护理将加强与艾滋病毒相关服务和其他服务的联系。通过邀请男性参加艾滋病毒课程并随后提供检测机会来促进夫妻检测。 R21 将用于完成重要的开发工作，使我们能够将这种范式改变的模式带到撒哈拉以南非洲，并让我们能够大规模测试 CP-Africa 的功效。在基于社区的参与性研究原则的指导下，我们将在马拉维和坦桑尼亚开发和试点 CP-Africa，这两个国家的艾滋病毒感染率（11% 与 6%）、艾滋病毒检测率和预防母婴传播覆盖率不同。将与利益相关者合作制定 ANC 会议和活动、安排从业人员时间、会议空间、组建小组和促进对个体妇女艾滋病毒、预防母婴传播和其他所需服务进行后续行动的程序。撒哈拉以南非洲地区新的成果衡量标准将通过认知访谈进行验证。然后，我们将在 4 个地点试点整个 CP-Africa 一揽子计划，将 192 名女性随机分配到 CP-Africa 或个性化护理；获取基线、妊娠晚期和出生后 8 周的结果数据；对实施过程进行全过程评估，包括直接观察会议以及妇女和提供者的定性评估。这项研究的数据将被整理并用于完善 CP-Africa 方案，为临床试验做好准备。如果CP-Africa能够在两个非洲国家成功实施，这将提高在其他资源匮乏地区取得成功的可能性。