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

背景：南非(SA)孕妇感染艾滋病毒的风险很高。暴露前预防 在怀孕期间使用(Prep)在预防艾滋病毒方面既安全又有效。然而，创伤后应激障碍 (与亲密伴侣暴力和/或其他创伤有关)和抑郁对PrEP产生负面影响 南澳妇女的依从性。应对创伤后应激和抑郁可能会改善PrEP 在怀孕和哺乳期间的坚持和坚持(即随时间持续的PrEP坚持)， 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 针对共同潜在因素的认知行为干预的可行性和可接受性 创伤后应激和抑郁改善孕期PrEP的依从性和持久性 产后过渡。候选人：我是马萨诸塞州的临床心理学家和博士后研究员 综合医院/哈佛医学院。我正在申请为期五年的K23职业发展奖，以获得 使我能够成为(1)独立调查员的培训、指导和研究经验 在R01级和(2)一名减少低收入国家妇女预防艾滋病毒的心理障碍方面的专家 资源设置。指导：Conall O‘Cleirigh博士将担任我的主要导师；他带来了 全球背景下艾滋病毒预防和干预发展的心理社会方面。克里斯蒂娜·普萨罗斯博士 杰西卡·哈贝勒，两位共同导师，将在定性数据分析应用于干预时提供指导 低收入和中等收入环境的发展和实施科学框架。兰登·迈尔博士， John Joska和Lucia Knight，我的SA合作导师，将在生物医学艾滋病毒预防方面提供指导 孕期/产后使用战略，南非背景下的干预发展，以及 产前诊所环境中的干预可持续性。生物统计学家罗伯特·帕克博士将担任 顾问。培训：针对干预措施的制定和实施进行定性分析方面的具体培训， 将在怀孕期间预防艾滋病毒，并为资源有限的环境制定心理社会治疗 通过密集的直接指导、课程作业、研讨会和SA的初步研究来实现。这次培训 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 爱滋病毒。研究：该项目的具体目标是(1)探索创伤后应激障碍的机制 抑郁通过定性访谈影响孕期PrEP的依从性和持久性；(2)发展 并对简短的PrEP遵守和持久性干预进行概念验证测试，以减少 创伤后应激和抑郁常见的心理机制对PrEP使用的负面影响， 并建立行为技能以改善自我照顾；以及(3)评估 在试点随机对照试验中，将纳入产前护理的干预措施。我们将使用这个 形成性研究申请R01级资助，以评估干预的有效性和有效性。

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.