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

制定强化的导师母亲战略，以改善艾滋病毒母婴传播 (PMTCT) 的预防结果

• 批准号: 10481028
• 负责人: JAMES G CARLUCCI
• 金额: $ 15.6万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10481028
• 关键词: Acquired Immunodeficiency Syndrome; Address; Advocate; Affect; Africa South of the Sahara; Age-Months; Caring; Cessation of life; Child; Clinic; Data; Development; Diagnostic; Educational workshop; Effectiveness; Event; Funding; Future; Goals; HIV; HIV Infections; Health; Human immunodeficiency virus test; Hybrids; Infant; Intervention; Interview; Kenya; Knowledge; Lactation; Leadership; Maternal and Child Health; Mentors; Mentorship; Meta-Analysis; Methods; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; Mothers; Outcome; Outcome Measure; Perception; Physicians; Prevention; Productivity; Randomized Clinical Trials; Research; Research Infrastructure; Research Methodology; Research Personnel; Resource-limited setting; Scientist; Services; Targeted Research; Testing; Vertical Disease Transmission; Viral; Viremia; Woman; Wool; career development; design; effectiveness implementation study; experience; follow-up; health care availability; implementation fidelity; implementation science; improved; low and middle-income countries; mortality; peer; person centered; pregnant; prevent; programs; research and development; risk minimization

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.

预防艾滋病毒母婴传播 (PMTCT) 计划为妇女提供一系列服务 感染艾滋病毒 (WLHIV) 的人，以保持健康并最大程度地降低感染艾滋病毒的婴儿 (HEI) 感染艾滋病毒的风险 艾滋病病毒。尽管撒哈拉以南非洲地区广泛实施了预防母婴传播服务，但只有三分之二的低艾滋病毒感染者 病毒受到抑制，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，针对阻止 WLHIV 及其 HEI 感染的因素 实现 PMTCT 护理的全部益处。导师母亲 (MM) 是支持 WLHIV 和 HEI 促进改善 PMTCT 成果。虽然 MM 在这方面表现出了希望，但很明显“一刀切” “所有”方法缺乏对以下事实的响应：一些 WLHIV 和 HEI 需要最低限度的支持，而其他人则需要最低限度的支持 有特定需求。需要进行研究以了解 MM 可以使用哪些策略来解决已知因素 影响 PMTCT 结果，以及如何在现实世界中最好地实施这些策略 设置。该提案旨在通过以下方式解决知识差距并促进最佳的 PMTCT 结果： 以人为本的增强型 MM 策略的开发，重点关注所面临的具体问题 WLHIV 和 HEI 的影响，以及 PMTCT 计划的现实限制。中心假设是 这种增强的 MM 策略可以以高可接受性和保真度来实施，从而改进 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检验这一假设。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 对 MM 和 WLHIV 进行定性访谈（包括那些有或没有不利的 PMTCT 结果的人） [损耗、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 策略的障碍，以及 (iii) 克服这些障碍的方法。在子目标 1b 中，我们 将与主要实施利益相关者（MM、PMTCT 计划）举办参与式设计研讨会 领导层和临床工作人员）制定增强的 MM 策略，具有可持续发展的最佳潜力 执行。目标 2：对增强型 MM 进行试点混合类型 3 实施效果研究 战略。增强的 MM 策略将在一家诊所实施。我们将使用混合方法 彻底评估增强型 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成果措施将提供初步有效性数据。我们预计这项 K23 提案将 提高我在艾滋病毒实施科学、定性和混合方法研究以及个人研究方面的专业知识 以参与式设计为中心，同时生成支持未来所需的令人信服的初步数据 R01 申请增强 MM 策略的实用集群随机临床试验。这些K23 研究和职业发展活动将在我作为 R01 资助的独立人士过渡时达到顶峰， 医生科学家。