Falling off the HIV treatment cascade cliff: understanding postpartum attrition to HIV care

摆脱艾滋病毒治疗级联悬崖：了解艾滋病毒护理的产后流失

• 批准号: 10196960
• 负责人: Christina Psaros
• 金额: $ 50.57万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-09 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10196960
• 关键词: AIDS prevention; Address; Adherence; Affect; Area; Behavior; Behavior Therapy; Behavioral; Biological Assay; Birth; Blood; Boston; Caring; Child; Clinic; Cohort Studies; Communities; Complementary Health; Contraceptive methods; Data; District Hospitals; Economics; Enrollment; Female; Funding; Future; Goals; Guidelines; HIV; Health; Health Personnel; Healthcare; Healthcare Systems; High Prevalence; Immunization; Incidence; Individual; Infant; Intervention; Interview; Lead; Learning; Link; Maternal Health; Maternal Mortality; Mental Health; Modeling; Mothers; Motivation; Newborn Infant; Outcome; Participant; Patient Recruitments; Patient Self-Report; Patients; Perinatal transmission; Phase; Policies; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Process; Prospective Studies; Province; Qualitative Methods; RNA; Research; Research Personnel; Risk; Risk Factors; Science; Sexual Partners; South Africa; Structure; Time; United States National Institutes of Health; Ursidae Family; Vertical Disease Transmission; Visit; Woman; Women' s Health; Work; antenatal care; barrier to care; base; burden of illness; care providers; depressive symptoms; fall risk; falls; health of the mother; male; maternal morbidity; postpartum care; prevent; primary outcome; programs; retention rate; risk minimization; social; social stigma; therapy design; therapy development; transmission process; treatment as usual; treatment risk

Successful management of HIV over time demands continued engagement with the healthcare system. South Africa bears a substantial degree of HIV disease burden, with well over 7 million people living with HIV at the end of 2015. In the province of KwaZulu-Natal, approximately 40% of women enrolled in antenatal care are living with HIV, the highest prevalence of HIV among pregnant women in the world. In addition to focusing on preventing mother to child transmission (PMTCT), pregnancy is a unique time to engage women in lifelong HIV care. There are many consequences of failing to remain in HIV care postpartum. For example, women who are not retained in HIV care postpartum may or may not complete infant specific PMTCT behaviors, increasing the risk of transmitting HIV to their infant. Failing to optimize the health of mothers has the potential to lead to increased rates of HIV related orphanhood, the risks of which have been well documented and include greater risk of HIV acquisition, adverse mental health outcomes, and economic insecurity. Women not on treatment risk transmitting HIV to male partners. Lastly, opportunities to provide complementary health care (e.g., contraception) are missed. While some studies have examined adherence to postpartum PMTCT guidelines, few of these focus on continued engagement in HIV care by the mother, and very few of them examine engagement in care beyond six months postpartum. Thus, the goal of this application is to study the trajectory of women living with HIV during the postpartum period in order to identify risk factors for falling out of care, and to learn about facilitators of care that may inform subsequent intervention development. Our study will occur in two phases. In Aim 1, we will collect data from 500 women living with HIV for a period of 2 years after delivery in order to identify who is most likely to remain in or fall out of HIV care during the postpartum period. We will collect HIV RNA and self-reported contact with a health care provider every three months (visit constancy) as co-primary outcomes. Our assessment of barriers and facilitators is informed by a socio-ecological model of HIV care that has been modified based on our prior work with this population. We will then conduct individual, in-depth interviews with a subset of women and their male pregnancy partners from Aim 1 for Aim 2; (1) women who achieved suppressed HIV RNA for at least two consecutive assessments (N=12-15, based on thematic saturation), (2) women who did not achieve suppressed HIV RNA for at least two consecutive assessments (N=12-15, based on thematic saturation), and (3) women who move from suppressed HIV RNA to unsuppressed HIV RNA (or the reverse; N=12-15, based on thematic saturation). We also will interview a subset of the male partners of each of these female participants (N= 12-15 per each group). This project builds upon and existing and successful team of collaborators based in Durban, South Africa, and Boston, MA. The information learned from this project will lead to interventions to better support HIV care among postpartum women, by informing us who is most at risk for falling out of care, and on what factors intervention is needed.

随着时间的推移，艾滋病毒的成功管理需要与医疗保健系统的持续接触。南 非洲承受着相当大程度的艾滋病毒疾病负担， 2015年底在夸祖鲁-纳塔尔省，约40%的产前保健登记妇女是 艾滋病毒感染者中，孕妇艾滋病毒感染率最高。除了关注 预防母婴传播（PMTCT），怀孕是一个独特的时间让妇女终身艾滋病毒 在乎产后未能继续接受艾滋病毒护理会产生许多后果。例如， 不保留在艾滋病毒护理产后可能会或可能不会完成婴儿特定的PMTCT行为，增加 将艾滋病毒传染给婴儿的风险。未能优化母亲的健康有可能导致 与艾滋病毒有关的艾滋病发病率增加，其风险已得到充分记录， 艾滋病毒感染风险、不良心理健康结果和经济不安全。未接受治疗的妇女 有将艾滋病毒传染给男性伴侣的风险。最后，提供补充保健的机会（例如， 避孕药，错过了。虽然一些研究已经检查了产后PMTCT指南的依从性， 其中很少关注母亲继续参与艾滋病毒护理，也很少研究 产后六个月以上的护理。因此，本应用程序的目标是研究 - 对感染艾滋病毒的妇女在产后期间的情况进行调查，以确定失去护理的风险因素，以及 了解护理促进者，为后续干预措施的制定提供信息。我们的研究将在 两个阶段。在目标1中，我们将收集500名感染艾滋病毒的妇女在分娩后两年的数据 以确定谁最有可能在产后期间继续接受或退出艾滋病毒护理。我们将 每三个月收集一次HIV RNA并自我报告与卫生保健提供者的接触（访视稳定性）， 共同主要成果。我们对障碍和促进因素的评估是由一个社会生态模型提供的， 艾滋病毒护理已经根据我们以前对这一人群的工作进行了修改。我们将进行个人， 对目标1中的一部分妇女及其男性妊娠伴侣进行深入访谈，以了解目标2;（1） 至少连续两次评估达到HIV RNA抑制的女性（N=12-15，基于 主题饱和），（2）至少连续两次未实现HIV RNA抑制的女性 评估（N=12-15，基于主题饱和度），和（3）从抑制HIV RNA转移到 到未抑制的HIV RNA（或相反; N=12-15，基于主题饱和度）。我们还将采访一位 这些女性参与者中的每一个的男性伴侣的子集（每组N= 12-15）。该项目建立 基于现有的和成功的合作者团队，总部设在南非德班和马萨诸塞州波士顿。的 从该项目中获得的信息将导致采取干预措施，更好地支持产后妇女的艾滋病毒护理。 妇女，告诉我们谁最有可能失去护理，以及需要干预的因素。

项目成果

"I am scared, I do not want to lie": exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa.

• DOI: 10.1186/s12884-023-05520-w
• 发表时间: 2023-04-03
• 期刊: BMC pregnancy and childbirth
• 影响因子: 3.1

Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa.

南非艾滋病毒感染妇女产后参与艾滋病毒护理的前瞻性评估方案。

• DOI: 10.1136/bmjopen-2019-035465
• 发表时间: 2020
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Psaros,Christina;Stanton,AmeliaM;Bedoya,CAndres;Mosery,Nzwakie;Evans,Shannon;Matthews,LynnTurner;Haberer,Jessica;Vangel,Mark;Safren,Steven;Smit,JenniferA
• 通讯作者: Smit,JenniferA