Integration of a collaborative care model for mental health services into HIV care for pregnant and postpartum women in Kenya (the Tunawiri Study)

将心理健康服务协作护理模式纳入肯尼亚孕妇和产后妇女的艾滋病毒护理（图纳维里研究）

• 批准号: 10676019
• 负责人: Lisa Lynn Abuogi
• 金额: $ 59.69万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676019
• 关键词: AIDS prevention; Address; Adopted; Africa South of the Sahara; Anxiety; Behavioral; Caring; Case Manager; Chronic; Clinic; Clinical; Communities; Complex; Comprehensive Health Care; Cost Analysis; Cost Effectiveness Analysis; Cost effectiveness research; County; Data; Data Collection; Educational workshop; Effectiveness; Electronics; Ensure; Evidence based intervention; Exploration, Preparation, Implementation, and Sustainment; Failure; Family; Focus Groups; Goals; Government; HIV; HIV diagnosis; Health; Health care facility; Health system; Healthcare; Healthcare Systems; Hybrids; Income; Infant; Intervention; Interview; Kenya; Lead; Link; Maternal Health; Maternal and Child Health; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Methods; Modeling; Mothers; Outcome; Patients; Perinatal; Perinatal Care; Pharmaceutical Preparations; Policies; Policy Maker; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Outcome; Pregnant Women; Primary Care; Primary Health Care; Probability; Process; Protocols documentation; Provider; Psychiatric Nursing; Psychiatrist; Psychosocial Assessment and Care; Recovery; Request for Applications; Research; Resource-limited setting; Risk; Self Efficacy; Services; Social Environment; Specialist; Symptoms; System; Techniques; Testing; Training; Translating; United States National Institutes of Health; Viral; Viral Load result; Woman; Work; acceptability and feasibility; antenatal; antenatal care; antiretroviral therapy; anxiety symptoms; care burden; care outcomes; clinic ready; collaborative care; common treatment; cost; cost effective; cost effectiveness; design; dissemination research; effectiveness/implementation trial; efficacious intervention; efficacious treatment; experience; health goals; health service use; implementation barriers; implementation outcomes; implementation strategy; implementation study; improved; informant; interdisciplinary approach; intimate partner violence; low and middle-income countries; meetings; model building; peer coaching; perinatal mental health; postpartum care; postpartum health; problem solving therapy; scale up; social determinants; social health determinants; social stigma; support tools

Common mental disorders (CMD) of depression and anxiety are prevalent and largely untreated among Kenyan pregnant and postpartum women living with HIV (PPWH). CMD lead to poor maternal and child health outcomes and contribute to lack of HIV care engagement and virologic failure in PPWH. While efficacious treatments for CMD exist, scaling treatment within routine health care in low- and middle-income (LMIC) settings will require stakeholder engagement and both effectiveness and implementation data to inform scale up and sustainability. Our team has integrated other efficacious interventions into antenatal (ANC) and HIV care in Kenya. We now propose to integrate proven mental health services using a collaborative care model, combined with a low intensity evidence-based intervention (problem solving therapy), while targeting known social determinants of HIV-related health for PPWH (stigma and IPV). Building on the current multidisciplinary approach for HIV care in Kenya, our proposed Collaborative Care Model (CCM) will utilize existing peer mentor mothers, non-specialist behavioral care managers, and psychiatric nurses; and will incorporate a consultant psychiatrist into the ANC/HIV care team. Guided by the EPIS (Exploration-Preparation-Implementation-Sustainment) framework, the overall study goal is to integrate collaborative care for perinatal CMD within routine ANC/HIV services in Kenya, assess the costs and cost-effectiveness of this approach, and work with policy and decision makers to determine key considerations for scale-up. Specifically, in Aim 1, we will identify contextual barriers and facilitators to refine an optimal integration model for delivering collaborative care model using multi- method data collection (focus groups with providers, in-depth interviews with key informants, and a clinic readiness checklist). A workshop with our Advisory Board comprising both county and national level stakeholders, will allow us to translate findings into a locally relevant CCM. In Aim 2 we will test CCM PPWH health during depression retention Aim 3, we will refine CCM implementation strategies through cost-effectiveness and dissemination research. We will carry out costing and cost-effectiveness analysis and invite policy and decision-makers to participate in a nominal group technique process to elucidate factors for further scale up and sustainment of the CCM approach. Findings from this study will developing a scalable model adaptable to other LMIC settings, contributing to global HIV and maternal health goals while and addressing the burden of untreated CMD. in antenatal care for in a hybrid type 2 implementation-effectiveness trial using a stepped wedge design at 15 primary care facilities in southwestern Kenya . We will i ntroduce CCM care for PPWH diagnosed with CMD antenatal care. The co-primary health outcomes at 12 months postpartum will be (1) recovery from or anxiety symptoms in PPWH, and (2) proportion PPWH with sustained viral suppression and in HIV care. Key implementation outcomes are feasibility and acceptability. Finally, in

抑郁症和焦虑症等常见精神障碍 (CMD) 在肯尼亚人中很普遍，而且大多未得到治疗 感染艾滋病毒的孕妇和产后妇女 (PPWH)。 CMD 导致孕产妇和儿童健康状况不佳 并导致 PPWH 缺乏艾滋病毒护理参与和病毒学失败。在有效治疗的同时 CMD 存在，中低收入 (LMIC) 环境中的常规医疗保健范围内的扩展治疗将需要 利益相关者的参与以及有效性和实施数据，为扩大规模和可持续性提供信息。 我们的团队已将其他有效的干预措施纳入肯尼亚的产前 (ANC) 和艾滋病毒护理中。我们现在 建议使用协作护理模式并结合低 强度循证干预（问题解决疗法），同时针对已知的社会决定因素 PPWH 的 HIV 相关健康（耻辱和 IPV）。以当前艾滋病毒护理的多学科方法为基础 在肯尼亚，我们提出的协作护理模式 (CCM) 将利用现有的同伴导师母亲、非专业人士 行为护理经理和精神科护士；并将聘请一名心理咨询师 ANC/HIV 护理团队。在EPIS（探索-准备-实施-维持）框架的指导下， 总体研究目标是将围产期 CMD 的协作护理纳入常规 ANC/HIV 服务中 肯尼亚，评估这种方法的成本和成本效益，并与政策和决策者合作， 确定扩大规模的关键考虑因素。具体来说，在目标 1 中，我们将识别背景障碍并 促进者完善最佳集成模型，以使用多方提供协作护理模型 方法数据收集（与提供者的焦点小组、与关键知情人的深入访谈以及诊所 准备情况清单）。由县和国家级利益相关者组成的顾问委员会举办的研讨会， 将使我们能够将研究结果转化为本地相关的 CCM。在目标 2 中，我们将测试 CCM PPWH 健康 期间 沮丧 保留目标 3，我们将 通过成本效益和传播研究完善 CCM 实施策略。我们将 进行成本核算和成本效益分析，并邀请政策制定者和决策者参与名义上的 小组技术过程，以阐明进一步扩大和维持 CCM 方法的因素。发现 这项研究将开发一个适用于其他中低收入国家环境的可扩展模型，为全球艾滋病毒和 孕产妇健康目标，同时解决未经治疗的 CMD 的负担。 在产前护理中 在混合类型 2 实施效果试验中，在 15 个初级上使用阶梯式楔形设计 肯尼亚西南部的护理设施。我们将为诊断患有 CMD 的 PPWH 引入 CCM 护理 产前护理。产后 12 个月的共同主要健康结果将是 (1) PPWH 中的焦虑症状，以及 (2) 具有持续病毒抑制的 PPWH 比例和 在艾滋病毒护理方面。关键的实施成果是可行性和可接受性。最后，在