Integrating HIV and Depression Self Care to Improve Adherence in Perinatal Women

整合艾滋病毒和抑郁症自我护理以提高围产期妇女的依从性

基本信息

批准号：
8910785
负责人：
Nancy R Reynolds
金额：
$ 22.52万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-15 至 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8910785
关键词：
AIDS clinical trial group Address Adherence Adverse effects Area Attention Behavior Car Phone Caring Child Child Care Child health care Clinic Clinical Comorbidity Coping Skills Counseling Country Development Developmental Delay Disorders Disease Education Experimental Designs Gender HIV HIV-1 Health Health Priorities Health behavior Health behavior outcomes Healthcare Home environment India Infant Informal Social Control Intervention Intervention Studies Knowledge Language Life Maternal Health Maternal and Child Health Measures Medical Mental Depression Mental Health Modeling Mood Disorders Mothers Office Nursing Outcome Participant Patients Perinatal Perinatal Care Persons Pharmaceutical Preparations Phase Pilot Projects Postpartum Period Problem Solving Procedures Process Protocols documentation Provider Public Health RNA Randomized Randomized Controlled Trials Research Resources Risk Role Rural Self Care Services Staging System Target Populations Testing Text Time Training Visit Woman Women&apos s Health adverse outcome care seeking daily functioning depressive symptoms efficacy trial evidence base global health health care service high risk improved innovation intervention effect literacy medication compliance men multi-component intervention neglect novel perinatal complications peripartum depression pilot trial rural area social stigma theories treatment adherence urban area

项目摘要

DESCRIPTION (provided by applicant): Women in low-resource countries are at high risk for co-morbid HIV and perinatal depression, yet are the least likely to obtain mental health and HIV treatment services because of a variety of personal, practical and organizational constraints. Independently, HIV and perinatal depression place women and their children at risk for poor health outcomes; together, these co-morbidities interact to compound the risk, having serious consequences for maternal, child, and public health outcomes. The proposed study will directly address this important, but neglected area by evaluating the feasibility and preliminary efficacy of an innovative intervention approach, BEST-maCARE [Better Education, Support, Treatment for maternal Capacity, Adherence, REtention in care]. The multi-component intervention is integrated into routine perinatal care and uses adjunctive mobile phone counseling, a promising, sustainable way to reach and engage women with co-morbid conditions in care and improve health outcomes. Most mobile phone interventions tested in limited-resource settings have relied on SMS text messaging. A phone counseling approach appears to be a more suitable for addressing the health challenges faced by women in resource-limited settings because many women have difficulties deciphering even simple text messages given literacy and language barriers. The intervention approach has been found effective in improving adherence and self-care behavior of persons living with HIV in the U.S., but its usefulness in addressing significant gaps in care among women with co-morbid conditions in a different socio-cultural, limited resource setting has not been examined. This project will use an evidence- based, time and resource-efficient process (ADAPT-ITT) to modify the intervention for delivery in different socio-cultural setting than originally created. The study will be conducted over two years in Bangalore, India, an ideal setting given high rates of depression and HIV among women, wide spread use of mobile phones in rural and urban areas, and fitting bi-national, complementary expertise of the multi-disciplinary team. During the first year we conduct elicitation research with patients and providers (n=35) in antenatal public clinics in Bangalore to deepen our understanding of the understanding of dynamics of risk among women embedded in socio-culturally constrained roles and leverage points for intervention. During the second year of the project, in accordance with the aims of a Stage Ib pilot trial, we will conduct test the feasibility and explore preliminay effect of the intervention to prepare for a full scale efficacy trial (R01). We will employ a two-am randomized between-groups experimental design (Best-maCare versus an attention control condition) and examine standardized, repeated dependent measures of clinical outcomes and process variables at 5 time points over 24-weeks.

描述（由申请人提供）：资源匮乏国家的妇女患有艾滋病毒和围产期抑郁症的高风险，但由于各种个人、实际和组织限制，她们获得心理健康和艾滋病毒治疗服务的可能性最小。独立而言，艾滋病毒和围产期抑郁症使妇女及其子女面临健康状况不佳的风险；这些合并症相互作用，加剧了风险，对孕产妇、儿童和公共卫生结果产生严重后果。拟议的研究将通过评估创新干预方法 BEST-maCARE [更好的教育、支持、治疗孕产妇能力、依从性、护理保留] 的可行性和初步功效，直接解决这一重要但被忽视的领域。这种多组成部分的干预措施被纳入常规围产期护理中，并使用辅助手机咨询，这是一种有前景、可持续的方式，可以帮助患有共病的妇女接受护理并改善健康结果。在资源有限的环境中测试的大多数手机干预措施都依赖于短信。电话咨询方法似乎更适合解决资源有限环境中妇女面临的健康挑战，因为由于识字和语言障碍，许多妇女甚至难以解读简单的短信。研究发现，这种干预方法可以有效改善美国艾滋病毒感染者的依从性和自我护理行为，但它对于解决不同社会文化、有限资源环境中患有共病的女性在护理方面的巨大差距也很有用。尚未经过检查。该项目将使用基于证据、时间和资源高效的流程 (ADAPT-ITT) 来修改干预措施，以便在与最初创建的不同社会文化环境中提供服务。该研究将在印度班加罗尔进行两年多的时间，鉴于妇女抑郁症和艾滋病毒发病率高、农村和城市地区移动电话的广泛使用以及跨国公司的互补性专业知识，印度班加罗尔是一个理想的环境。纪律小组。第一年，我们在班加罗尔的产前公共诊所对患者和提供者（n=35）进行了启发式研究，以加深我们对处于社会文化受限角色和干预杠杆点的女性风险动态的理解。项目第二年，按照Ib期先导试验的目标，进行可行性检验，探索干预措施的初步效果，为全面疗效试验（R01）做准备。我们将采用凌晨两点随机组间实验设计（Best-maCare 与注意力控制条件），并在 24 周内的 5 个时间点检查临床结果和过程变量的标准化、重复相关测量。