Implementing Comprehensive PMTCT and HIV Prevention for South African Couples

为南非夫妇实施全面的预防母婴传播和艾滋病毒预防

• 批准号: 8875095
• 负责人: Deborah Lynne Jones
• 金额: $ 32.19万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-29 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8875095
• 关键词: AIDS prevention; Address; Adherence; Adoption; African; Age-Months; Barrier Contraception; Behavior Therapy; Behavioral; Breast Feeding; Caring; Child; Clinic; Clinical; Communication; Community Health Centers; Conceptions; Country; Couples; Decision Making; Disclosure; Effectiveness of Interventions; Enrollment; Ensure; Epidemic; Family; Family Planning; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Policy; Human immunodeficiency virus test; Incidence; Individual; Infant; Infant Care; Intention; Intervention; Knowledge; Laboratories; Measures; Mothers; National Institute of Allergy and Infectious Disease; Nature; Newborn Infant; Outcome; Participant; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Postpartum Period; Pregnancy; Pregnant Women; Prevalence; Prevention; Process; Protocols documentation; Province; Public Health; Randomized; Recruitment Activity; Risk; Risk Reduction; Rural; Rural Community; Services; South Africa; Testing; Treatment Protocols; Vertical Disease Transmission; Vulnerable Populations; Wife; Woman; arm; base; cohort; design; effective therapy; evidence base; falls; feeding; improved; intimate partner violence; male; medication compliance; men; policy implication; postnatal; pregnant; prevent; programs; reproductive; safer sex; scale up; sex risk; social; social stigma; transmission process; uptake

DESCRIPTION (provided by applicant): In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available "prevention of mother-to-child transmission" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be "necessary, but not sufficient" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the "Vikela Umndeni: Protect Your Family" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.

描述（由申请人提供）：在南非农村，在社区卫生中心寻求产前护理的艾滋病毒+孕妇中只有三分之二充分利用了2010年的“预防母亲到孩子传播”（PMTCT）服务（SADOH）。尽管鼓励男性伴侣的参与作为增加PMTCT吸收的潜在手段，但男性一直不愿陪同妻子/伴侣接受产前护理。 最近的研究通常支持男性参与促进PMTCT，但是该参与的性质和影响尚不清楚和未经测试。同样很明显，诸如污名，披露和亲密伴侣暴力等因素对PMTCT摄取和保留的护理构成了重大障碍，这表明男性参与可能“必要但不足”，以实现<5％的婴儿艾滋病毒hiv发病率的WHO目标。可能需要采取其他措施来增加艾滋病毒阳性孕妇在PMTCT中的参与。 2011年，Mpumalanga省的艾滋病毒率是该国的最高（36.7％），而农村诊所的婴儿艾滋病毒发病率的率高达50％。该省的PMTCT吸收率一直是南非最低的（69％）。 This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT在产前和产后期间，包括母乳喂养和计划生育在内的方案。 拟议的研究将从12个随机分配的社区卫生中心（6个实验，6个对照）中招募的两名HIV阳性孕妇招募：a）a）妇女没有男性伴侣参加的妇女（n = 720）（n = 720），b）妇女与男性伴侣（n = 720个伙伴）（n = 720构想），以确定男性参与的影响，以确定男性参与的影响，是在男妇的影响下，是否有效地养成了习惯，并有效地构成了行为介入的影响。产后。这是我们的 intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men从充分利用他们及其婴儿可用的治疗机会。基于我们的试点研究的令人鼓舞的初步结果，成功采用了“ Vikela Umndeni：保护您的家庭”计划，可能对在南非农村地区最脆弱的人群中占据流行的影响可能具有重大的公共卫生政策：HIV+ HIV+孕妇及其婴儿。