Asha Improving Health and Nutrition of Indian Women with AIDS and Their Children

阿莎改善印度艾滋病妇女及其子女的健康和营养

• 批准号: 9085393
• 负责人: Maria L. Ekstrand
• 金额: $ 56.61万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-23 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9085393
• 关键词: 8 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anthropometry; Biolectric Impedance; Biological Markers; Body Composition; Car Phone; Caring; Child; Child Care; Cholesterol; Clinical Trials Design; Collaborations; Communities; Computers; Consumption; Data; Data Collection; Development; Diet; Disease Progression; Environment; Face; Family member; Fatty acid glycerol esters; Federal Government; Focus Groups; Food; Food Supplementation; Food Supplements; Funding; Grant; Growth; Growth and Development function; HIV; HIV Seropositivity; Health; Immune; India; Infant; Intake; Intervention; Life; Light; Lipids; Longitudinal Studies; Macronutrients Nutrition; Malnutrition; Measures; Mental Health; Methodology; Methods; Minerals; Mission; Modeling; Monitor; Mothers; Muscle; National Institute of Mental Health; Nutrition Assessment; Nutritional; Nutritional Science; Nutritional Support; Outcome; Pilot Projects; Pregnant Women; Proteins; Published Comment; Publishing; Recommendation; Research; Research Personnel; Risk; Rural; Rural Health; Rural Population; Social Work; Supplementation; Technology; Testing; Time; Training; Treatment Protocols; Triglycerides; Underweight; Vitamins; Weight Gain; Wireless Technology; Woman; Women Status; Work; aged; antiretroviral therapy; arm; base; coping; depressive symptoms; design; experience; follow-up; improved; indexing; intervention program; lean body mass; meetings; muscle form; novel; nutrition; nutrition education; physical conditioning; post intervention; primary outcome; programs; scale up; social stigma; therapy adherence; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): Rural women living with AIDS (WLA) in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. Furthermore, they are generally underweight and malnourished, with adherence to antiretroviral therapy (ART) at levels lower than 50%. While the Indian Government's National Rural Health Mission utilizes a successful model to address the health needs of the rural population by training village women as Ashas (Accredited Social Work Activists) to enhance health of pregnant women and their infants, the focus on rural WLA needs to be significantly strengthened. U.S. and Indian collaborators recently completed an R34 pilot study which has demonstrated successful improvement in ART adherence, CD4 levels, and physical and mental health among rural Indian WLA. In total, 34 rural intervention WLA were supported by grant-trained, HIV-focused Ashas who provided assistance to WLA in decreasing barriers to ART adherence and provided protein supplementation compared to equal numbers of usual care WLA who received minimal protein supplementation. While very successful, our Asha pilot study monitored only WLA, despite the fact that many rural children are also at risk for delayed physical growth and psychomotor development. More importantly, we were not able to separate the nutritional component from the care and support component of the Asha, did not incorporate nutritional biomarkers, and were limited by only a six-month follow-up. In light of the mandate to advance both the science of nutrition and sustainability in real settings, our experienced team proposes to build on and extend our successful pilot work to meet this need, by assessing the incremental advantages of nutritional support to Asha care and support alone, and the impact of these programs on an index child (oldest between 3-8 years). In addition, we will take advantage of rural India's excellent mobile phone coverage and computer technology for both wireless data collection and data transfer. The proposed longitudinal study will use a 2x2 factorial design, specifically, 1) Asha support alone for WLA , vs. 2) Asha support for WLA + nutrition (food-based) training, vs. 3) Asha support for WLA + food supplementation, vs. 4) Asha support for WLA + nutrition training + food supplementation, to test the effects of nutrition training and/or food supplementation on primary outcomes of anthropometric parameters and immune status (CD4 levels) of the WLA at 6-, 12- and 18-month follow-up; and secondarily on ART adherence, psychological health, nutritional adequacy and lipid status of the WLA over time. Based upon reviewers' comments, among index children, we streamlined our assessments to include anthropometric parameters and psychomotor development; and among those HIV positive, immune status.

描述（由申请人提供）：印度有艾滋病的农村妇女（WLA）在获得和遵循治疗方案，照顾家庭成员以及保持积极的心理健康方面面临着深远的挑战。此外，它们通常体重不足和营养不良，并遵守低于50％的抗逆转录病毒疗法（ART）。尽管印度政府的国家农村卫生任务利用成功的模式来解决农村人口的健康需求，通过训练乡村妇女作为ASHA（认可的社会工作者）来增强孕妇及其婴儿的健康，但需要大大加强对WLA农村的关注。美国和印度的合作者最近完成了一项R34试点研究，该研究表明，印度WLA农村地区的艺术依从性，CD4水平以及身心健康的成功改善。总共有34个农村干预WLA得到了以授予培训的，以HIV为中心的ASHA的支持，他们为WLA提供了帮助，以减少ART依从性的障碍，并提供补充蛋白质的蛋白质，与接受最少蛋白质补充蛋白质的常规护理WLA相比。尽管非常成功，但我们的ASHA试点研究仅监视了WLA，尽管许多农村儿童也面临延迟身体成长和精神运动发展的风险。更重要的是，我们无法将营养成分与ASHA的护理和支持成分分开，没有包含营养生物标志物，并且仅限制了六个月的随访。鉴于在真实环境中提高营养和可持续性科学的任务，我们经验丰富的团队建议通过评估营养支持对ASHA护理和单独支持的营养支持的增量优势来建立并扩展我们成功的飞行员工作以满足这一需求，以及这些计划对索引孩子的影响（在3-8岁之间）。此外，我们将利用印度农村的出色手机覆盖范围和计算机技术，用于无线数据收集和数据传输。拟议的纵向研究将使用2x2阶乘设计，特别是1）仅ASHA支持WLA，vs. 2）ASHA对WLA +营养（基于食物）培训的支持，与3）ASHA对WLA +食物补充的支持，vs. 4）ASHA对ASHA对ASHA的支持，以供ASHA + NUTITION培训培训 +营养培训，或者在及时培训培训，或者在推广培训中，或者在营养培训，或者在营养培训中，或者营养不良，或者营养不良的效果，或效果。 WLA的人体测量参数和免疫状态（CD4水平）在6个，12个月和18个月的随访中；其次，随着时间的流逝，WLA的艺术依从性，心理健康，营养充足和脂质状态。根据审稿人的评论，在索引儿童中，我们简化了评估，以包括人体测量参数和心理运动发展；在那些艾滋病毒阳性，免疫地位中。