Developing an enhanced Mentor Mother strategy to improve prevention of mother-to-child transmission of HIV (PMTCT) outcomes

预防艾滋病毒母婴传播方案为生活在艾滋病毒/艾滋病社区的妇女提供一系列服务。 艾滋病毒感染者（WLHIV），以保持他们的健康，并尽量减少他们的艾滋病毒暴露婴儿（HEI）获得 艾滋病。尽管在撒哈拉以南非洲广泛实施了预防母婴传播服务，但只有三分之二的WLHIV感染者 病毒抑制，近40%的HEI失访或在18个月大时死亡。有一个 迫切需要制定以人为本的战略，针对预防WLHIV及其HEI的因素， 实现预防母婴传播护理的全部益处。导师母亲（MM）是支持WLHIV的同伴倡导者， 高等教育倡议促进改善预防母婴传播的成果。虽然MM在这方面表现出了承诺，但很明显， 所有”的方法缺乏对以下事实的响应，即一些WLHIV和HEI需要最低限度的支持，而另一些 有特定的需求。需要研究来了解MM可以使用什么策略来解决已知的因素 影响PMTCT结果，以及如何在现实世界中以高保真度最好地实施这些策略 设置.该提案旨在通过以下方式填补知识空白并促进最佳的预防母婴传播成果： 以人为中心的增强型MM战略的开发，重点关注所面临的具体问题 由WLHIV和HEI，以及PMTCT计划的现实世界的限制。核心假设是， 这种增强的MM策略可以以高的可接受性和保真度来实现，从而改善 预防母婴传播的结果。我们将通过针对以下具体目标的研究来验证这一假设。目标1： 使用参与式研究方法来制定增强的MM策略。在子目标1a中，我们将执行 MM和WLHIV的定性访谈（包括有和没有不利的PMTCT结果的患者 [自然减员、病毒血症或垂直传播]），以确定：（i）对当前MM策略的可行增强，（ii） 优化MM战略的障碍，以及（iii）克服这些障碍的方法。在次级目标1b中， 将与关键实施利益相关者（MM、PMTCT计划）一起举办参与式设计研讨会 领导层和诊所工作人员），以制定具有可持续发展最佳潜力的增强型MM策略 实施.目标2：对增强型MM进行试点混合型3实施有效性研究 战略将在一家诊所实施增强的MM策略。我们将使用混合方法 彻底评估增强MM策略的可接受性、可行性和保真度。事前事后评估 关键的预防母婴传播结果指标将提供初步的有效性数据。我们希望K23提案能够 提高我在艾滋病毒实施科学，定性和混合方法研究，和人的专业知识， 以参与式设计为中心，同时生成支持未来所需的引人注目的初步数据 R 01应用于增强MM策略的实用性群集随机临床试验。K23 研究和职业发展活动将最终在我过渡到独立作为一个R 01资助， 物理学家兼科学家

Prevention of mother-to-child transmission of HIV (PMTCT) programs offer a range of services to women living with HIV (WLHIV) to maintain their health and minimize the risk of their HIV-exposed infants (HEI) acquiring HIV. Despite widespread implementation of PMTCT services in sub-Saharan Africa, only two-thirds of WLHIV are virally suppressed, and nearly 40% of HEI are lost to follow-up or die by 18 months of age. There is a critical need to develop person-centered strategies targeting the factors preventing WLHIV and their HEI from realizing the full benefits of PMTCT care. Mentor Mothers (MM) are peer advocates who support WLHIV and HEI to promote improved PMTCT outcomes. While MM show promise in this regard, it is clear a “one size fits all” approach lacks responsiveness to the fact that some WLHIV and HEI need minimal support while others have specific needs. Research is needed to understand what strategies MM can use to address factors known to influence PMTCT outcomes, and how best to implement these strategies with high-fidelity in real-world settings. This proposal aims to address knowledge gaps and promote optimal PMTCT outcomes through person-centered development of an enhanced MM strategy that focuses on both the specific problems faced by WLHIV and HEI, as well as the real-world constraints of PMTCT programs. The central hypothesis is that this enhanced MM strategy can be implemented with high acceptability and fidelity, resulting in improved PMTCT outcomes. We will test this hypothesis through research targeted to the following Specific Aims. AIM 1: Use a participatory research approach to develop an enhanced MM strategy. In Sub-Aim 1a we will perform qualitative interviews with MM and WLHIV (both those with and without unfavorable PMTCT outcomes [attrition, viremia, or vertical transmission]) to identify: (i) feasible enhancements to the current MM strategy, (ii) barriers to optimizing the MM strategy, and (iii) approaches to overcoming these barriers. In Sub-Aim 1b we will conduct participatory design workshops with key implementation stakeholders (MM, PMTCT program leadership, and clinic staff) to develop an enhanced MM strategy with optimal potential for sustainable implementation. AIM 2: Conduct a pilot hybrid type 3 implementation-effectiveness study of the enhanced MM strategy. The enhanced MM strategy will be implemented at one clinic. We will use a mixed-methods approach to thoroughly assess acceptability, feasibility, and fidelity to the enhanced MM strategy. A pre-post assessment of key PMTCT outcome measures will provide preliminary effectiveness data. We expect this K23 proposal to advance my expertise in HIV implementation science, qualitative and mixed-methods research, and person- centered participatory design while also generating the compelling preliminary data needed to support a future R01 application for a pragmatic cluster randomized clinical trial of the enhanced MM strategy. These K23 research and career development activities will culminate in my transition to independence as an R01-funded, physician-scientist.