Integration of stepped care for Perinatal Mood and Anxiety Disorders among Women Living with HIV in Kenya

肯尼亚艾滋病毒感染妇女围产期情绪和焦虑障碍的分级护理一体化

基本信息

批准号：
10677075
负责人：
Amritha Subray Bhat
金额：
$ 61.4万
依托单位：
KENYATTA NATIONAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-19 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10677075
关键词：
Address Adoption Affect Anxiety Anxiety Disorders Caring Client Cluster randomized trial Consolidated Framework for Implementation Research Counseling Country Data Development Educational workshop Ensure Equity Evidence based intervention Facility Controls Feedback Fetal Growth Retardation Focus Groups Generalized Anxiety Disorder HIV Health Health Personnel Health care facility Hybrids Infant Intervention Interview Kenya Learning Low Birth Weight Infant Mental Depression Mental Health Mental Health Services Methods Modeling Mood Disorders Mother-to-child HIV transmission Names Outcome Patients Penetration Perinatal Perinatal Care Policy Maker Postpartum Period Postpartum Women Pregnancy Pregnancy Outcome Pregnancy loss Pregnant Women Premature Birth Prevalence Prevention Primary Care Proctor framework Program Effectiveness Provider Quality of life Questionnaires Randomized Recommendation Resource-limited setting Risk Services Specialist Structure Supervision Surveys Symptoms Technology Teleconferences Testing Training Travel Viral Visit Wait Time Woman World Health Organization adverse pregnancy outcome antenatal anxiety symptoms arm care delivery care outcomes cost depressive symptoms design disability effectiveness evaluation effectiveness outcome experience hybrid type 2 trial implementation barriers implementation outcomes implementation strategy improved informant intervention delivery intervention program low and middle-income countries meetings mental health policy multidisciplinary perinatal mental health perinatal women pregnant primary care setting primary outcome programs response routine care routine screening screening secondary outcome service delivery skills social stigma standard of care stillbirth success telepsychiatry therapy design treatment arm treatment of anxiety disorders

项目摘要

PROJECT SUMMARY/ABSTRACT Perinatal mood and anxiety disorders (PMAD), defined as depression and anxiety during pregnancy or up to 1 year postpartum, affect 10-20% of pregnant and postpartum women, with elevated burden in low- and middle- income countries (LMICs, >20%) and among women living with HIV (WLWH, >25%). Meeting the need for PMAD treatment among WLWH in LMICs requires integration of evidence-based interventions (EBIs) into routine antenatal and prevention of mother to child HIV transmission (PMTCT) services. In Kenya, such efforts have been prioritized in national mental health policy strategy, but their delivery has been limited by lack of provider training and poor linkage across provider cadres (e.g., primary care and mental health providers). There is a need for development and testing of tailored interventions that strengthen workforce capacity and facilitate linkage across provider cadres, as well as implementation strategies to facilitate high- quality intervention delivery. We have identified three EBIs to promote perinatal mental health: (1) universal mental health screening, (2) the Problem Management Plus (PM+) counseling intervention for women experiencing PMAD, and (3) telepsychiatry for women with severe symptoms or no response to PM+. We propose to combine these interventions in a stepped care model, named the Integrated Perinatal Mental Health program (IPMH), and develop implementation strategies to support its integration into routine PMTCT care in Kenya. We will then evaluate IPMH’s effectiveness and implementation outcomes in a Hybrid Type II cluster-randomized trial in 20 healthcare facilities in Western Kenya, the region with the highest HIV prevalence in the country. In Aim 1, we will use participatory design to optimize and adapt IPMH and develop implementation strategies. In Aim 2, we will determine the effect of IPMH and its implementation strategies on mental health, HIV care, and pregnancy outcomes among WLWH from pregnancy to 6 months postpartum. In Aim 3, we will determine effect of IPMH and its implementation strategies on service delivery and implementation outcomes, and identify multilevel drivers of successful implementation. We hypothesize that provision of the IPMH stepped care intervention in routine PMTCT services, along with tailored implementation strategies, will (1) lead to lower depression and anxiety symptoms, lower adverse pregnancy outcomes, and better quality of life; and (2) increase penetration and equity of care provision to WLWH experiencing PMAD. IPMH has potential to address a critical gap in treatment of PMAD among WLWH in resource-limited settings. Completion of these aims will generate rigorous data on both IPMH’s effectiveness and the implementation strategies for high quality and sustainable delivery of a ready-to-scale intervention.

项目概要/摘要围产期情绪和焦虑障碍 (PMAD)，定义为怀孕期间抑郁和焦虑或最多 1 产后一年，影响 10-20% 的孕妇和产后妇女，中低收入人群的负担增加满足 PMAD 的需求。中低收入国家 WLWH 的治疗需要将循证干预措施 (EBI) 纳入常规治疗产前和预防艾滋病毒母婴传播 (PMTCT) 服务。在肯尼亚，此类努力已被列为国家精神卫生政策战略的优先事项，但其实施却受到限制。由于缺乏提供者培训以及提供者干部之间的联系较差（例如初级保健和心理健康）需要制定和测试增强劳动力的定制干预措施。能力并促进提供者干部之间的联系，以及促进高水平的实施战略质量干预实施。我们确定了三个促进围产期心理健康的 EBI：(1) 普遍心理健康筛查，(2) 针对患有 PMAD 的女性进行问题管理加 (PM+) 咨询干预，以及 (3) 远程精神病学对于症状严重或对 PM+ 无反应的女性，我们建议将这些干预措施结合起来。阶梯式护理模式，命名为综合围产期心理健康计划（IPMH），并制定然后，我们将支持其纳入肯尼亚常规预防母婴传播护理的实施战略。在混合 II 类整群随机试验中评估 IPMH 的有效性和实施结果肯尼亚西部地区的 20 个医疗机构是该国艾滋病毒感染率最高的地区。在目标 1 中，我们将使用参与式设计来优化和调整 IPMH 并制定实施策略。在目标 2 中，我们将确定 IPMH 及其实施策略对心理健康、艾滋病毒护理和在目标 3 中，我们将确定 WLWH 从怀孕到产后 6 个月的妊娠结局。 IPMH 及其在服务提供和实施结果方面的战略实施情况，并确定成功实施的多层次驱动因素。我们勇于在常规 PMTCT 服务中提供 IPMH 分级护理干预，以及量身定制的实施策略，将（1）导致降低抑郁和焦虑症状，降低不良反应妊娠结局和更好的生活质量；(2) 提高护理服务的普及率和公平性； WLWH 经历 PMAD。 IPMH 有潜力弥补资源有限环境中 WLWH 治疗 PMAD 的关键差距。这些目标的完成将产生关于 IPMH 有效性和高质量和可持续地提供现成规模干预措施的实施战略。