Perinatal Depression, Stigma, Social Capital Utilization and PMTCT Adherence

围产期抑郁、耻辱、社会资本利用和 PMTCT 依从性

• 批准号: 8517205
• 负责人: Christina Psaros
• 金额: $ 17万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517205
• 关键词: AIDS prevention; Academic Training; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Africa; Africa South of the Sahara; Age; Area; Award; Behavior; Behavior Therapy; Biometry; Child; Child health care; Childhood; Chronic Disease; Clinic; Clinical; Communities; Complement; Counseling; Data; Developing Countries; Development; Enrollment; Epidemic; Epidemiology; Face; Faculty; General Hospitals; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health behavior; Healthcare; Individual; Infant; Infant Mortality; Infection; International; Intervention; K-Series Research Career Programs; Left; Life; Massachusetts; Maternal Health; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Mothers; Outcome; Pathway interactions; Pattern; Perinatal; Personal Satisfaction; Play; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Labor; Preventive Intervention; Problem behavior; Protocols documentation; Province; Psychologist; Public Health Schools; Reproductive Health; Research; Research Activity; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Review Literature; Risk Behaviors; Role; Series; Services; Social Network; South Africa; Statistical Methods; Structure; Techniques; Testing; Time; Training; Uganda; United Nations; Universities; Ursidae Family; Vertical Disease Transmission; Woman; Women' s Health; Work; antiretroviral therapy; base; burden of illness; career; disturbance in affect; experience; improved; innovation; interest; mathematical model; medical schools; meetings; mortality; novel; patient oriented research; prevent; programs; reproductive; social; social capital; social stigma; success; therapy adherence; therapy development; transmission process

DESCRIPTION (provided by applicant): The United Nations Millennium Development Goals (MDGs) illustrate key areas in which the lives of women and children worldwide are in need, including improving maternal health and a reduction in childhood mortality. The success of meeting both these goals depends on reducing rates of vertical transmission of HIV. Sub-Saharan Africa is one of the areas targeted by the MDGs and bears a substantial degree of HIV disease burden, with well over 22 million people living with HIV at the end of 2008, a significant number of whom are women of reproductive age. Depression has been associated with non-adherence to the series of health behaviors known as preventing mother-to-child transmission (PMTCT) of HIV. Women in resource limited settings are likely to face additional barriers to PMTCT adherence, including stigma and structural barriers. While structural barriers may be circumvented by relying on community resources (known as social capital), depression and stigma may make it difficult to access these resources. Thus, understanding the role of modifiable factors that contribute to PMTCT adherence is critical to meeting the goals of the MDGs. Candidate: I am a clinical psychologist and recently transitioned to faculty at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain training and mentorship in order to become an independent investigator at the R01 level, and an expert in depression and adherence to health behaviors important to the health of HIV infected women in resource limited settings. Mentoring: Both my primary mentor (Safren) and co-mentor (Bangsberg) have protected time to devote to my mentorship via K24 Mid-Career Investigator Awards in Patient-Oriented Research. Both are experts in the field of antiretroviral therapy adherence in international settings. Dr. Safren is aso an expert in depression and behavioral intervention development. In addition, I have assembled a team of consultants with expertise in other critical aspects of my proposal, including women's reproductive health (Smit), PMTCT (Peltzer), stigma (Kalichman), social networks and health (Christakis), and biostatistics (Ghebremichael). Research: The goals of the proposed project are to (1) investigate the relationships among perinatal depression, stigma, social capital utilization PMTCT adherence, and (2) to test a pilot intervention to treat perinatal depression and improve adherence to ARVs among HIV infected women in a resource limited setting. Training: My research activities will be supported by structured meetings with my mentors and coursework in advanced statistical methods, psychiatric epidemiology, and healthcare in developing countries at the Harvard School of Public Health, the timing of which will complement my proposed research activities. My exceptional mentoring team, strong institutional support, innovative research questions, and my commitment to addressing issues relevant to the health of HIV infected women and their children leave me well positioned to achieve my goal of becoming an independent investigator.

描述（由申请人提供）：联合国千年发展目标 (MDG) 阐述了全世界妇女和儿童生活中需要的关键领域，包括改善孕产妇健康和降低儿童死亡率。能否成功实现这两个目标取决于降低艾滋病毒垂直传播率。撒哈拉以南非洲地区是千年发展目标的目标地区之一，承担着相当大的艾滋病毒疾病负担，截至 2008 年底，艾滋病毒感染者人数远远超过 2,200 万人，其中很大一部分是育龄妇女。抑郁症与不遵守一系列被称为预防艾滋病毒母婴传播 (PMTCT) 的健康行为有关。资源有限环境下的妇女在坚持预防母婴传播方面可能会面临额外障碍，包括耻辱和结构性障碍。虽然结构性障碍可以通过依赖社区资源（称为社会资本）来规避，但抑郁和耻辱可能会使人们难以获得这些资源。因此，了解有助于坚持预防母婴传播的可改变因素的作用对于实现千年发展目标至关重要。候选人：我是一名临床心理学家，最近转任马萨诸塞州总医院/哈佛医学院的教员。我正在申请为期五年的 K23 职业发展奖，以获得培训和指导，以便成为 R01 级别的独立调查员，以及在资源有限的情况下成为抑郁症和坚持对艾滋病毒感染妇女的健康至关重要的健康行为方面的专家设置。指导：我的主要导师 (Safren) 和共同导师 (Bangsberg) 都预留了时间，通过 K24 面向患者的研究中职业生涯中期研究者奖来对我进行指导。两人都是国际环境下抗逆转录病毒治疗依从性领域的专家。 Safren 博士也是抑郁症和行为干预开发方面的专家。此外，我还组建了一支顾问团队，他们在我的提案的其他关键方面拥有专业知识，包括妇女生殖健康（Smit）、预防母婴传播（Peltzer）、耻辱（Kalichman）、社交网络和健康（Christakis）以及生物统计学（Ghebrmichael） ）。研究：拟议项目的目标是 (1) 调查围产期抑郁症、耻辱感、社会资本利用 PMTCT 依从性之间的关系，以及 (2) 测试一项试点干预措施，以治疗围产期抑郁症并提高艾滋病毒感染妇女对抗逆转录病毒药物的依从性在资源有限的环境中。培训：我的研究活动将得到与导师的结构化会议以及哈佛大学公共卫生学院高级统计方法、精神病流行病学和发展中国家医疗保健课程的支持，其时间安排将补充我提议的研究活动。我出色的指导团队、强大的机构支持、创新的研究问题以及我对解决与艾滋病毒感染妇女及其子女健康相关问题的承诺，使我有能力实现成为一名独立调查员的目标。