Using Enhanced Peer Group Strategies to Support Option B+ in Uganda

在乌干达使用增强的同侪群体策略支持选项 B

• 批准号: 8898174
• 负责人: MARY Glenn Fowler
• 金额: $ 68.11万
• 依托单位: MU-JHU CARE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8898174
• 关键词: Adherence; Adopted; Africa South of the Sahara; Anti-Retroviral Agents; Antiretroviral resistance; Appointment; Attitude; Blood; Breast Feeding; CD4 Lymphocyte Count; Caring; Cessation of life; Child; Client; Clinic; Clinical; Communities; Counseling; Country; Couples; Data; Diagnosis; Disclosure; Dose; Effectiveness; Enrollment; Evaluable Disease; Family; Family Planning; Focus Groups; Fostering; Friends; Goals; Guidelines; HIV; Hair; Health; Health Benefit; Health Policy; Health education; Hospitals; Income; Individual; Infant; Intervention; Learning; Life; Location; Long-Term Care; Maps; Maternal Health; Measures; Mothers; Participant; Patient Self-Report; Peer Group; Personal Satisfaction; Pharmaceutical Preparations; Plasma; Policies; Policy Maker; Postpartum Period; Pregnancy; Pregnant Women; Prevention; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Regimen; Reporting; Research; Resources; Risk; Rural; Sampling; Services; Site; Support System; System; Time; Travel; Uganda; Update; Viral; Viral Load result; Visit; Woman; World Health Organization; antiretroviral therapy; arm; base; drug distribution; economic outcome; empowered; falls; feeding; follow-up; group support; health economics; improved; innovation; male; meetings; nutrition; nutrition education; open label; peer; pregnant; primary outcome; programs; prophylactic; psychosocial; randomized trial; research study; residence; scale up; screening; sexual HIV transmission; standard of care; success; therapy design; transmission process; trial comparing

DESCRIPTION (provided by applicant): The Uganda's Ministry of Health (MOH) in October 2012 adopted Option B+ (life-long triple antiretroviral therapy [ART]) for the prevention of mother-to-child HIV transmission (PMTCT). The national scale up of option B+ provides an opportunity to eliminate mother-to-child HIV transmission (MTCT) in Uganda. However, adherence to life-long triple ART by HIV-infected pregnant women in resource-limited settings presents unique challenges given disruptions in normal routines often with travel upcountry and difficulties of life time adherence among generally healthy women after the risk of transmitting HIV to their infant has ceased. The overall goal of this operational research to be conducted in urban and rural Uganda is to improve adherence to option B Plus among HIV-infected pregnant and newly delivered mothers. We will use formative research followed by a randomized clinical trial of an enhanced compare a community based intervention to improve maternal adherence to appointments and taking ARVs. Our hypothesis is that the community-based peer group support strategy called 'Friends for Life Circles' combining drug access, health education and income- generating activities will be more effective to support women to adhere to their treatment and care visits and to their drugs to achieve and maintain viral suppression and minimize MTCT of HIV when compared to the current MOH approach to support mothers adherence to option B+. The specific aims of this operational research are: AIM 1: To conduct formative research to assess individual, family and community attitudes regarding Option B plus. AIM 2: To conduct a randomized controlled trial that compares community-based peer group support versus Ministry of Health hospital-based standard of care for Option B plus. AIM 3: To evaluate the adherence to option B plus and effectiveness of the community- based peer group support intervention compared to Ministry of Health hospital-based standard of care for Option B plus. The formative research will inform the implementation of the community-based group peer support intervention. The research will be conducted as a randomized clinical trial. A total of 540 evaluable HIV-infected women enrolled during pregnancy will be randomized to either Friends for Life Circles (FLC) or the standard MOH counseling on adherence in a rural and an urban district of Central Uganda. HIV-infected women assigned to the group peer support (FLC) arm will meet on a monthly basis in the community and participate in the circles. Group sessions will include drug distribution, counseling on adherence to ARVs and follow-up visits, male partner disclosure, infant feeding and nutrition, and promotion of psychosocial well-being. Income-generating activities will be used to foster sustainability of the Circles after the period of risk of transmission of HIV to the infant has ceased. In partnership with the MOH, the findings from the Friends for Life Circles will be evaluated and the successful components and lessons learned will be documented to inform the scaling up of the intervention within the districts and nationally.

描述（由申请人提供）：乌干达卫生部 (MOH) 于 2012 年 10 月采用了方案 B+（终身三联抗逆转录病毒疗法 [ART]）来预防艾滋病毒母婴传播 (PMTCT)。方案 B+ 在全国范围内的扩大为乌干达消除艾滋病毒母婴传播 (MTCT) 提供了机会。然而，在资源有限的环境中，感染艾滋病毒的孕妇坚持终生三重抗逆转录病毒治疗面临着独特的挑战，因为前往内地旅行通常会扰乱正常的生活习惯，而且一般健康的妇女在面临将艾滋病毒传播给她们的风险后，很难终生坚持接受艾滋病毒治疗。婴儿已停止。这项在乌干达城市和农村进行的业务研究的总体目标是提高感染艾滋病毒的孕妇和刚分娩的母亲对选项 B Plus 的依从性。我们将利用形成性研究，然后进行随机临床试验，对基于社区的干预措施进行增强比较，以提高母亲对预约和服用抗逆转录病毒药物的依从性。我们的假设是，名为“生命圈之友”的基于社区的同侪团体支持策略将药物获取、健康教育和创收活动结合起来，将更有效地支持妇女坚持接受治疗和护理就诊，并坚持使用药物与目前卫生部支持母亲遵守选项 B+ 的方法相比，实现并维持病毒抑制并最大限度地减少 HIV 母婴传播。 这项业务研究的具体目标是： 目标 1：进行形成性研究，评估个人、家庭和社区对选项 B plus 的态度。目标 2：进行一项随机对照试验，比较基于社区的同伴团体支持与卫生部基于医院的选项 B plus 护理标准。目标 3：与卫生部基于医院的选项 B 加护理标准相比，评估对选项 B 加的遵守情况以及基于社区的同伴团体支持干预的有效性。形成性研究将为基于社区的团体同伴支持干预的实施提供信息。该研究将作为一项随机临床试验进行。总共 540 名怀孕期间可评估的艾滋病毒感染妇女将被随机分配到生命圈之友 (FLC) 或乌干达中部农村和城市地区的标准卫生部咨询处。分配到团体同伴支持（FLC）部门的艾滋病毒感染妇女将每月在社区聚会并参与圈子。小组会议将包括药物分发、抗逆转录病毒药物依从性咨询和随访、男性伴侣披露、婴儿喂养和营养以及促进社会心理健康。在婴儿感染艾滋病毒的风险期结束后，创收活动将用于促进圆圈的可持续性。将与卫生部合作，对生命圈之友的调查结果进行评估，并将记录成功的组成部分和吸取的经验教训，为在各地区和全国范围内扩大干预措施提供信息。