Understanding the role of food insecurity and depression in non-adherence to Option B+ among perinatal Kenyan women living with HIV: a Syndemics approach

了解粮食不安全和抑郁症在感染艾滋病毒的围产期肯尼亚妇女中不遵守选项 B 中的作用：一种流行病方法

• 批准号: 10424410
• 负责人: emily tuthill
• 金额: $ 19.74万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-18 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424410
• 关键词: Address; Adherence; Affect; Africa South of the Sahara; Automobile Driving; Biological Markers; Breast Feeding; Breastfed infant; Clinical Management; Clinical Psychology; Complex; Consequentialism; Counseling; Data; Development; Diagnosis; Disease Progression; Educational workshop; Evaluation; Exclusive Breastfeeding; Food; Goals; Grant; Guidelines; HIV; HIV Infections; Hair; Health; Health behavior change; Individual; Infant; Infant Food; Infant Health; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Kenya; Longitudinal Studies; Maternal Health; Maternal and Child Health; Measures; Mental Depression; Mental Health; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; Mothers; Nurses; Outcome; Patient Self-Report; Perinatal; Personal Satisfaction; Persons; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Prevention Research; Prevention strategy; Prophylactic treatment; Psychology; Randomized; Reading; Research; Research Design; Research Personnel; Research Training; Resource-limited setting; Risk; Role; Sampling; Scientist; Techniques; Testing; Theory of Change; Time; Training; Vertical Disease Transmission; Viral Load result; Visit; Woman; Women' s Health; Work; World Health Organization; acceptability and feasibility; antiretroviral therapy; base; biobehavior; career; cohort; depressive symptoms; design; evidence base; experience; feasibility testing; feeding; follow-up; food insecurity; improved; improved outcome; infant nutrition; innovation; longitudinal analysis; longitudinal design; meetings; mortality; mother nutrition; nutrition; perinatal HIV; perinatal intervention; perinatal period; perinatal women; peripartum depression; pregnant; prenatal; prevent; programs; protective factors; public health relevance; routine care; success; syndemic; theories; therapy adherence; therapy design; therapy development; treatment research

Project Summary/Abstract Strategies to prevent mother-to-child transmission (PMTCT) of HIV can reduce the risk of vertical transmission to less than 2%, but difficulties in adhering to the three pillars of PMTCT (maternal ART; exclusive breastfeeding; provision of ART prophylaxis to infant; i.e., Option B+) has led to high rates of MTCT in sub- Saharan Africa and suboptimal maternal and infant health. The goals of the proposed research are to 1) gain an understanding of the influences and mechanisms by which food insecurity (FI) and perinatal depression- two modifiable determinants of PMTCT Option B+ non-adherence-interact to impact Option B+ adherence and 2) refine our conceptual framework to aid in intervention development that assists mothers to maintain Option B+ adherence. Candidate: I am a nurse-scientist with a background in health behavior change theory and infant feeding in the context of HIV. I am applying for a K23 Career Development Award to obtain training, mentorship, and research experience to become an expert and independent investigator in theory-based, multi-level intervention design impacting maternal and infant health in the context of HIV in low-resource settings. Mentoring: I have put together an exceptional mentoring team with extensive experience in HIV treatment and prevention research in Kenya. Drs. Sheri Weiser and Craig Cohen will serve as co-Primary mentors and bring complementary expertise in HIV treatment and prevention, maternal and child health, FI, conceptual framework refinement, and development and implementation of multi-level interventions in Kenya. My co-mentors and scientific advisors round out my team to bring specific content and methods expertise and are based both in the U.S and in Kenya, including: Dr. Mallory Johnson (clinical psychology, multi-level intervention design and evaluation; feasibility implementation; ART adherence); Dr. Monica Gandhi (clinical management of HIV, objective ART adherence); Dr. Elizabeth Bukusi (HIV in the Kenyan context, maternal adherence), Dr. Sera Young (maternal and infant nutrition and FI, PMTCT considerations in intervention design), and Dr. Tor Neilands (psychology, quantitative methods, design and analysis of longitudinal data). Training: I propose to obtain training in FI, perinatal ART adherence, longitudinal quantitative study design and analysis, and theory-based multi-level intervention development and evaluation. Training will be achieved through mentor meetings, coursework, workshops, directed readings and primary research in Kenya. Research: The goals of the proposed research are to 1) identify factors that increase risk for or protect against FI and perinatal depression among HIV+ women during pregnancy and postpartum; 2) investigate the interplay of FI and perinatal depression on adherence to PMTCT guidelines over time among an existing cohort of perinatal women in Kenya; 3) develop a multi-level intervention and test feasibility with full scale testing in a planned R01 submission in year 5.

项目概要/摘要 预防艾滋病毒母婴传播 (PMTCT) 的策略可以降低垂直传播的风险 低于 2%，但难以坚持 PMTCT 的三大支柱（孕产妇 ART；独家 哺乳;为婴儿提供抗逆转录病毒疗法预防；即选项 B+）导致子母婴传播率较高 撒哈拉非洲和孕产妇和婴儿健康欠佳。拟议研究的目标是 1) 获得 了解粮食不安全（FI）和围产期抑郁症的影响和机制 PMTCT 选项 B+ 不依从的两个可修改的决定因素相互作用，影响选项 B+ 的依从性和 2) 完善我们的概念框架，以帮助制定干预措施，帮助母亲维持选择权 B+ 依从性。候选人：我是一名护士科学家，具有健康行为改变理论背景 艾滋病毒背景下的婴儿喂养。我正在申请 K23 职业发展奖以获得培训， 指导和研究经验，成为基于理论的专家和独立研究者， 在资源匮乏的艾滋病毒背景下影响孕产妇和婴儿健康的多层次干预设计 设置。指导：我组建了一支出色的指导团队，在艾滋病毒方面拥有丰富的经验 肯尼亚的治疗和预防研究。 博士。 Sheri Weiser 和 Craig Cohen 将担任联合小学 指导并带来艾滋病毒治疗和预防、孕产妇和儿童健康、FI、 概念框架的完善以及肯尼亚多层次干预措施的制定和实施。 我的共同导师和科学顾问充实了我的团队，为我带来具体的内容和方法的专业知识和 位于美国和肯尼亚，包括： Mallory Johnson 博士（临床心理学、多层次 干预设计和评估；可行性实施；艺术依从性）；莫妮卡·甘地博士（临床 HIV 管理、客观的 ART 依从性）； Elizabeth Bukusi 博士（肯尼亚背景下的艾滋病毒、孕产妇 Sera Young 博士（母婴营养和 FI、PMTCT 干预注意事项 设计）和 Tor Neilands 博士（心理学、定量方法、纵向数据的设计和分析）。 培训：我建议获得 FI、围产期 ART 依从性、纵向定量研究设计和 分析以及基于理论的多层次干预开发和评估。训练将达到 通过在肯尼亚的导师会议、课程作业、研讨会、定向阅读和初步研究。 研究：拟议研究的目标是 1）确定增加风险或预防风险的因素 HIV+ 妇女在怀孕期间和产后的 FI 和围产期抑郁症； 2）研究相互作用 随着时间的推移，现有队列中 FI 和围产期抑郁症对 PMTCT 指南依从性的影响 肯尼亚的围产期妇女； 3) 制定多层次的干预措施并通过全面测试来测试可行性 计划在第 5 年提交 R01。