Maximizing adherence /retention for women /infants in the context of Option B+, Kenya

在选项 B 的背景下，肯尼亚最大限度地提高妇女/婴儿的依从性/保留率

• 批准号: 9045675
• 负责人: Lisa Lynn Abuogi
• 金额: $ 35.1万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-12 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9045675
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Africa South of the Sahara; Anti-Retroviral Agents; Breast Feeding; CD4 Lymphocyte Count; Car Phone; Caring; Child health care; Clinical; Communities; Community Health; Country; Diagnosis; Discrimination; Drops; Education; Ensure; Epidemic; Evidence based intervention; Fright; Funding; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Personnel; Health Services; Health care facility; Individual; Infant; Infant Health; Infant Mortality; Intervention; Kenya; Knowledge; Life; Malawi; Maternal Health; Maternal Mortality; Maternal and Child Health; Measures; Mentors; Meta-Analysis; Methods; Modeling; Mother-to-child HIV transmission; Mothers; Motivation; Neonatal; Outcome; Pharmaceutical Preparations; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Primary Health Care; Process; Province; Public Health; Qualitative Research; Randomized; Reaction; Recommendation; Reporting; Research; Research Methodology; Resources; Rural; Services; Site; Staging; Testing; Text; Vertical Disease Transmission; Viral Load result; Visit; Woman; antiretroviral therapy; base; design; effective intervention; evidence base; experience; family support; follow-up; improved; male; mentoring community; pediatric human immunodeficiency virus infection; pregnant; primary outcome; scale up; secondary outcome; service utilization; social; social stigma; standard of care; theories; therapy adherence; treatment program; uptake

DESCRIPTION (provided by applicant): In order to eliminate new pediatric HIV infections, save maternal lives, and simplify antiretroviral therapy (ART) implementation in settings with generalized HIV epidemics, current WHO guidance recommends lifelong triple ART for all pregnant and breastfeeding women (Option B+). However, despite the promise of Option B+ to remove logistical barriers and to promote maternal health through life-long ART, this strategy brings challenges. Key amongst these challenges is adherence to ART and continuous retention in HIV care, especially for women who do not require ART for their own health. Barriers to adherence and retention in care for prevention of mother-to-child transmission (PMTCT) have been identified at the individual, interpersonal, community, and health facility levels; yet specific barriers in the context of Option B+ are not well understood. Our study will b conducted at 20 health facilities and associated communities in Nyanza Province, Kenya where MTCT rates prior to Option B+ roll-out remained near 10%, despite the wide availability of PMTCT services. As Option B+ is scaled up in Kenya, it is essential to identify effective methods to ensure long-term adherence and retention in care for mother-baby pairs, throughout pregnancy, breastfeeding, and beyond. Building on our team's prior research experience in this setting, we propose to gain understanding of and address potential barriers at the individual, community, and health facility levels through formative research with HIV-positive pregnant and postpartum women, their male partners, and health care providers. This information will be used to refine two proposed interventions that are highly likely to maximize ART adherence and retention in care among HIV-infected pregnant women and HIV-exposed infants. These interventions will be rigorously tested in rural Kenya; using a cluster randomized 2x2 factorial designs. The evidence-based interventions to be tested will include 1) community Mentor Mothers (cMM) who will provide support for ART adherence and retention in care for HIV-positive women in the community and 2) individually tailored, theory- based mobile phone text messages to help retain women and infants in HIV care. Our overall goal is to determine which intervention (or combination of interventions) maximizes ART adherence and retention in care in the context of Option B+ and thus improves maternal and infant health outcomes. Our primary outcomes will include ART adherence at 12 months postpartum and retention in care, measured by a documented HIV care visit within 90 days prior to 12 months postpartum. Secondary outcomes will include MTCT at 6 weeks, 12 months and 18 months; as well as maternal viral loads and CD4 counts. Results from this study will inform the scale-up of Option B+ in Kenya by identifying effective interventions and combinations of interventions that can reduce barriers and increase facilitators of optimal ART adherence and retention in care with the aims of reaching the elimination of mother to child transmission of HIV and significantly improving maternal health.

描述（由申请人提供）：为了消除新的儿科艾滋病毒感染，挽救孕产妇的生命并简化抗逆转录病毒疗法（ART）在具有广义艾滋病毒流行病的情况下实施，当前WHO指导建议所有怀孕和胸食的女性终身三重艺术（选项B+）。然而，尽管B+有望消除后勤障碍并通过终身艺术促进孕产妇健康，但该战略带来了挑战。这些挑战的关键是遵守艺术和在艾滋病毒护理中的持续保留，尤其是对于不需要艺术以自己健康的妇女而言。在个人，人际关系，社区和医疗机构水平上已经确定了遵守和保留预防母亲传播（PMTCT）的障碍；然而，在选项B+的背景下的特定障碍尚不清楚。我们的研究将在肯尼亚Nyanza省的20个医疗机构和相关社区进行B进行，尽管PMTCT服务可用，但在期权B+推出之前的MTCT率仍然接近10％。随着肯尼亚的选项B+的扩大规模，必须确定确保在整个怀孕，母乳喂养及以后确保长期遵守和保留母子对的有效方法。在我们团队在此环境中的先前研究经验的基础上，我们建议通过与HIV阳性孕妇和产后妇女，男性伴侣以及医疗保健提供者的形成性研究来了解个人，社区和医疗机构水平的潜在障碍。这些信息将用于完善两种提出的干预措施，这些干预措施极有可能最大程度地提高艾滋病毒感染的孕妇和艾滋病毒暴露的婴儿的艺术依从性和保留率。这些干预措施将在肯尼亚农村进行严格测试；使用簇随机2x2阶乘设计。要测试的基于证据的干预措施将包括1）社区导师母亲（CMM），他们将为社区中的艾滋病毒阳性女性提供艺术依从性和保留率的支持； 2）单独量身定制的基于理论的手机短信，以帮助保留艾滋病毒护理中的妇女和婴儿。我们的总体目标是确定在选项B+的背景下，哪种干预措施（或干预措施组合）可以最大化艺术依从性和保留率，从而改善了母亲和婴儿的健康状况。我们的主要结果将包括产后12个月的艺术依从性和保留在护理中，并在产后12个月前的90天内通过记录的HIV护理访问来衡量。次要结果将包括6周，12个月零18个月的MTCT；以及母体病毒载荷和CD4计数。这项研究的结果将通过确定有效的干预措施和干预措施的组合来告知肯尼亚选项B+的扩大规模，从而减少障碍并增加最佳艺术依从性和保留率的促进者，以实现将母亲消除艾滋病毒传播的母亲，并显着改善孕产妇的健康。