Promoting HIV health behaviors among pregnant couples in Zambia using an adaptive relationship strengthening intervention

使用适应性关系强化干预措施促进赞比亚怀孕夫妇的艾滋病毒健康行为

• 批准号: 10398907
• 负责人: Karen Marie Hampanda
• 金额: $ 23.8万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10398907
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Affect; Africa South of the Sahara; Award; Behavior; Behavior Therapy; Behavioral; Birth; Caring; Child Health; Communication; Communities; Control Groups; Counseling; Couples; Diagnosis; Effectiveness; Elements; Epidemic; Evaluation; Exclusive Breastfeeding; Family; Family Planning; Female; Focus Groups; Foundations; Funding; Future; General Population; Goals; HIV; HIV Seropositivity; HIV prevention trial; Health; Health behavior; Human immunodeficiency virus test; Intervention; Intervention Trial; Interview; Link; Maternal Mortality; Measures; Mediation; Mental Health; Mentors; Mentorship; Methods; Modeling; Mothers; Outcome; Participant; Pathway interactions; Patient Self-Report; Phase; Postpartum Period; Postpartum Women; Pregnant Women; Prevalence; Prevention; Prevention strategy; Preventive; Public Health Schools; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Training; Resource-limited setting; Secure; Site; Social support; Surveys; Teaching Hospitals; Techniques; Testing; Therapeutic; Training; Universities; Vertical Disease Transmission; Viral; Viral Load result; Woman; World Health Organization; Zambia; antenatal care; antiretroviral therapy; arm; base; behavioral health; burden of illness; career; career development; conflict resolution; contextual factors; coping; design; evidence base; experience; follow-up; improved; instrument; intervention delivery; intervention effect; intimate partner violence; male; pediatric human immunodeficiency virus; pregnant; primary outcome; professor; programs; satisfaction; self esteem; service providers; service utilization; skills; social; social determinants; social stigma; success; tenure track; theories; therapy adherence; therapy design; treatment strategy; treatment trial; uptake

PROJECT SUMMARY/ABSTRACT Candidate: I am a behavioral health researcher with expertise in the social determinants of HIV, with a particular emphasis on prevention of mother-to-child transmission (PMTCT) in sub-Saharan Africa. My long-term career goal is to be a tenure-track professor in a school of public health with a robust research portfolio focused on family-based HIV prevention and treatment strategies. My prior training and experiences have enabled me to conduct rigorous research on the social and behavioral aspects of HIV in various global settings. However, to become a top investigator in my field capable of securing R01 funding, I require additional training and mentorship in intervention design and evaluation. The K99/R00 Pathway to Independence Award is a logical progression from my previous research and training. Under the mentorship of an exceptional team of researchers, I will focus my training phase of the award on career development activities that facilitate my transition to an independent behavioral HIV investigator capable of leading intervention trials in resource limited settings. Mentored Phase Research (K99, years 1-2): The effectiveness of PMTCT programs is dependent on optimizing pregnant and postpartum women’s adherence to antiretroviral therapy (ART) and sustained engagement in care. In high HIV prevalence settings of sub-Saharan Africa, such as Zambia, women are lost- to-follow up at alarming rates across the cascade of care. Contextual factors, such as relationship dynamics with male partners (relationship satisfaction, communication, conflict resolution), are a long-overlooked influence in women’s PMTCT-related health behaviors. Couples counseling interventions in the region have proven successful in strengthening relationships and promoting some HIV prevention behaviors, such couples HIV testing. In order to test if a couples counseling approach can extend to PMTCT outcomes in Zambia, I will refine a couples counseling intervention for HIV-positive pregnant women and their male partners (Aim 1). The intervention is based on elements of my mentors’ successful couples counseling models and uses a unique adaptive design. I will refine the content and delivery of the proposed intervention through qualitative interviews and focus groups with HIV-positive pregnant women, their male partners, and service providers, while engaging stakeholders and building my research capacity in this setting. Independent Phase Research (R00, Years 3- 5): I will implement a single-site randomized controlled trial of the couples counseling intervention (n=238 couples; 119 per arm) and assess service utilization and PMTCT outcome indicators, including women’s viral load at 9 months postpartum, self-reported ART adherence, and retention in PMTCT care (Aim 2). I will also establish the effect of the intervention on intra- and inter-personal mechanisms I hypothesize to be on the causal pathway influencing PMTCT outcomes (Aim 3) through behavioral surveys at baseline, 3 and 9 months postpartum. Future Directions: Findings from this study will provide evidence of the preliminary efficacy of the couples counseling intervention to promote PMTCT adherence and retention, which will be used to develop a larger multi-site R01 trial with longer-term HIV outcomes.

项目总结/摘要 候选人：我是一名行为健康研究人员，在艾滋病毒的社会决定因素方面具有专业知识， 强调在撒哈拉以南非洲预防母婴传播。我的长期职业生涯 我的目标是成为公共卫生学院的终身教授，拥有强大的研究组合，重点是 以家庭为基础的艾滋病毒预防和治疗战略。我之前的培训和经验使我能够 在各种全球环境中对艾滋病毒的社会和行为方面进行严格的研究。但要 成为我所在领域的顶级调查员，能够获得R 01资金，我需要额外的培训， 在干预设计和评价方面提供指导。K99/R 00独立之路奖是一个合乎逻辑的 从我以前的研究和训练的进展。在一个杰出的团队的指导下， 研究人员，我将把我的培训阶段的奖励职业发展活动，促进我的 过渡到一个独立的行为艾滋病毒调查员能够领导干预试验在资源有限 设置.指导阶段研究（K99，1-2年）：PMTCT计划的有效性取决于 优化孕妇和产后妇女坚持抗逆转录病毒治疗（ART）， 参与护理。在赞比亚等撒哈拉以南非洲艾滋病毒高流行地区， 以惊人的速度跟进整个护理级联。背景因素，如与 男性伴侣（关系满意度，沟通，解决冲突），是一个长期被忽视的影响， 妇女预防母婴传播相关的健康行为。该地区的夫妻咨询干预已经证明， 成功地加强关系和促进一些艾滋病毒预防行为，如夫妇艾滋病毒 试验.为了测试夫妻咨询方法是否可以扩展到赞比亚的PMTCT结果，我将 完善针对艾滋病毒抗体阳性孕妇及其男性伴侣的夫妻咨询干预措施（目标1）。的 干预是基于我的导师的成功的夫妇咨询模式的元素，并使用独特的 适应性设计我将通过定性访谈来完善所提议的干预措施的内容和实施方式 与艾滋病毒阳性孕妇、其男性伴侣和服务提供者进行接触， 在这种情况下，利益相关者和建设我的研究能力。独立阶段研究（R 00，3- 5）：我将实施一项关于夫妻咨询干预的单中心随机对照试验（n=238 夫妇;每组119人），并评估服务利用率和预防母婴传播的结果指标，包括妇女的病毒 产后9个月的负荷、自我报告的ART依从性和PMTCT护理的保留率（目标2）。我也会 建立干预对内部和人际机制的影响，我假设是因果关系 通过基线、3个月和9个月时的行为调查影响PMTCT结局的途径（目标3） 产后未来的方向：本研究的结果将提供证据，证明 夫妇咨询干预，以促进PMTCT的坚持和保留，这将用于制定一个 更大规模的多中心R 01试验，具有更长期的HIV结局。

项目成果

An mHealth pilot designed to increase the reach of prevention of mother-to-child transmission of HIV (PMTCT) across the treatment cascade in a resource-constrained setting in Tanzania.

一项移动医疗试点项目，旨在在坦桑尼亚资源有限的环境中通过治疗级联扩大预防艾滋病毒母婴传播 (PMTCT) 的范围。

• DOI: 10.1371/journal.pone.0212305
• 发表时间: 2019
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Thomas,DeborahSK;Bull,Sheana;Nyanza,EliasC;Hampanda,Karen;Liedtke,Michael;Ngallaba,SospatroE
• 通讯作者: Ngallaba,SospatroE

Men's perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis.

• DOI: 10.1186/s12889-021-11430-3
• 发表时间: 2021-07-08
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Matenga TFL;Zulu JM;Nkwemu S;Shankalala P;Hampanda K
• 通讯作者: Hampanda K