Reducing psychological barriers to PrEP persistence among pregnant and postpartum women in Cape Town, South Africa

背景：南非 (SA) 的孕妇感染艾滋病毒的风险很高。暴露前预防 怀孕期间使用 PrEP（暴露前预防）对于预防艾滋病毒既安全又有效。然而，创伤后应激 （与亲密伴侣暴力和/或其他创伤有关）和抑郁症对 PrEP 产生负面影响 南澳妇女的依从性。解决创伤后应激和抑郁可能会改善 PrEP 怀孕和母乳喂养期间的坚持和坚持（即随着时间的推移持续坚持 PrEP）， 这是艾滋病毒风险急剧增加的时期。该提案的总体目标是开发和测试 针对常见潜在因素的认知行为干预的可行性和可接受性 创伤后应激和抑郁症，以提高怀孕期间和怀孕期间 PrEP 的依从性和持久性 产后过渡。候选人：我是马萨诸塞州的一名临床心理学家和博士后研究员 综合医院/哈佛医学院。我正在申请五年期 K23 职业发展奖以获得 培训、指导和研究经验将使我能够成为 (1) 一名独立研究者 R01 级别和 (2) 减少低收入妇女艾滋病毒预防心理障碍的专家 资源设置。指导：Conall O’Cleirigh 博士将担任我的主要导师；他带来了以下方面的专业知识 全球背景下艾滋病毒预防和干预措施发展的心理社会方面。博士。克里斯蒂娜·普萨罗斯 和杰西卡·哈贝勒（Jessica Haberer），两位共同导师，将提供定性数据分析的指导，因为它适用于干预 低收入和中等收入环境的制定和实施科学框架。博士。兰登·迈尔, 我在南澳的共同导师约翰·乔斯卡 (John Joska) 和露西娅·奈特 (Lucia Knight) 将提供艾滋病毒生物医学预防方面的指导 怀孕/产后使用的策略、针对南非情况的干预措施制定，以及 产前诊所环境中干预的可持续性。生物统计学家罗伯特·帕克博士将担任 顾问。培训：针对干预措施制定和实施的定性分析的专门培训， 怀孕期间的艾滋病毒预防以及针对资源有限环境的心理社会治疗的开发将 通过在南澳进行密集的直接指导、课程作业、研讨会和初步研究来实现。本次培训 研究经验将使我能够支持有感染风险的女性的心理和性健康 艾滋病毒。研究：该项目的具体目标是（1）探索创伤后应激障碍的机制 通过定性访谈，抑郁症会影响怀孕期间 PrEP 的依从性和持久性； (2) 开发 并对简短的 PrEP 依从性和持久性干预进行概念验证测试，以减少 创伤后应激和抑郁症常见的心理机制对 PrEP 使用的负面影响， 培养行为技能以改善自我护理； (3) 评估方案的可行性和可接受性 干预措施将在一项试点随机对照试验中纳入产前护理。我们将使用这个 申请 R01 级资助的形成性研究，以评估干预措施的功效和效果。

Background: Pregnant women in South Africa (SA) are at high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) use during pregnancy is both safe and effective in preventing HIV. However, posttraumatic stress (associated with intimate partner violence and/or other traumas) and depression negatively impact PrEP adherence among women in SA. Addressing posttraumatic stress and depression will likely improve PrEP adherence and persistence (i.e., sustained PrEP adherence over time) during pregnancy and breastfeeding, which are periods of dramatically increased HIV risk. The overarching goal of this proposal is to develop and test the feasibility and acceptability of a cognitive behavioral intervention that targets common underlying factors of posttraumatic stress and depression to improve PrEP adherence and persistence during pregnancy and the postpartum transition. Candidate: I am a clinical psychologist and a postdoctoral fellow at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain the training, mentorship, and research experience that will enable me to become (1) an independent investigator at the R01 level and (2) an expert in reducing the psychological barriers to HIV prevention among women in low- resource settings. Mentoring: Dr. Conall O’Cleirigh will serve as my primary mentor; he brings expertise in the psychosocial aspects of HIV prevention and intervention development for global contexts. Drs. Christina Psaros and Jessica Haberer, both co-mentors, will offer guidance on qualitative data analysis as it applies to intervention development and implementation science frameworks for low- and middle-income settings. Drs. Landon Myer, John Joska, and Lucia Knight, my SA-based co-mentors, will provide mentorship on biomedical HIV prevention strategies for use during pregnancy/postpartum, intervention development for the South African context, and intervention sustainability within the antenatal clinic setting. Dr. Robert Parker, a biostatistician, will serve as a consultant. Training: Specific training in qualitative analysis for intervention development and implementation, HIV prevention during pregnancy, and psychosocial treatment development for resource-limited settings will be achieved through intensive direct mentorship, coursework, workshops, and primary research in SA. This training and research experience will enable me to support the mental and sexual health of women at risk for acquiring HIV. Research: The specific aims of the project are to (1) explore the mechanisms by which posttraumatic stress and depression impact PrEP adherence and persistence during pregnancy via qualitative interviews; (2) develop and conduct a proof-of-concept test of a brief PrEP adherence and persistence intervention that reduces the negative impact of psychological mechanisms common to posttraumatic stress and depression on PrEP use, and builds behavioral skills to improve self-care; and (3) evaluate the feasibility and acceptability of the intervention, which will be integrated into antenatal care, in a pilot randomized controlled trial. We will use this formative research to apply for an R01-level grant to evaluate the efficacy and effectiveness of the intervention.