A Structural Intervention To Integrate Reproductive Health Into HIV Care

将生殖健康纳入艾滋病毒护理的结构性干预措施

• 批准号: 7229646
• 负责人: Joanne Ellen Mantell
• 金额: $ 62.27万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-03-01 至 2012-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7229646
• 关键词: AIDS prevention; Abate; Accounting; Acquired Immunodeficiency Syndrome; Address; African; Algorithms; Arts; Attitude; Behavior; Belief; Biological; Caring; Child; Cities; Client; Clinic; Clinical; Compatible; Conceptions; Consensus; Contraceptive Agents; Contraceptive methods; Counseling; Country; Data; Decision Making; Developed Countries; Developing Countries; Development; Diagnosis; Economics; End Point; Ensure; Environment; Epidemic; Failure; Family Planning; Family Planning Personnel; Family Practice; Female Condoms; Fertility; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health Policy; Heterogeneity; Individual; Infant; Infection; International; Intervention; Interview; Lead; Life; Measures; Medical; Modeling; Morbidity - disease rate; NIH Office of AIDS Research; Numbers; Outcome; Outcome Assessment; Parents; Patient currently pregnant; Persons; Phase; Phase II Clinical Trials; Policies; Policy Analysis; Political Factor; Positioning Attribute; Pregnancy; Prenatal care; Prevention; Process; Professional counselor; Protocols documentation; Provider; Public Health; Public Health Schools; Public Sector; Randomized Controlled Trials; Recommendation; Reproductive Health; Reproductive Health Services; Reproductive History; Research; Research Design; Research Infrastructure; Research Personnel; Resources; Risk; Risk Reduction; Safety; Services; Severities; Site; South Africa; Staff Attitudes; Standards of Weights and Measures; Stigmata; Testing; Time; Translations; Treatment Efficacy; Universities; Unsafe Sex; Vertical Disease Transmission; Weight; Woman; Work; base; care systems; child bearing; concept; condoms; cost; cultural values; experience; follow-up; indium arsenide; innovation; male; men; metropolitan; mortality; pregnancy prevention; pressure; prevent; safer sex; social; social stigma; success; therapy design; tool; unintended pregnancy

DESCRIPTION (provided by applicant): In South Africa, neither general medical nor HIV-specific treatment practices routinely address issues of discordant/untested partners or the concurrent HIV protection needs and fertility goals of those who are HIV+. Women infected with HIV have insufficient information about contraception and parenting options, and these needs are inadequately addressed among HIV+ men. Regardless of societal or personal attitudes about the soundness of HIV-positive persons seeking conception, our pilot data from two Cape Town clinics show that nearly 50% of recently diagnosed HIV-positive women and men accessing HIV care for the first time are seeking or desirous of having children in the next year. A multi-level structural intervention that simultaneously addresses stigma and poor access to contraceptive services and introduces best-practices counseling approaches that maximize sexual risk reduction based on clients' personal situations is urgently needed. In the proposed study, we will (1) conduct formative research with key stakeholders to inform the development of a multi-level structural intervention to integrate sexual and reproductive health services into HIV clinical care; (2) develop a standardized counseling algorithm and decision-making tool that tailors safer sex, contraception, and fertility messages to HIV+ individuals' circumstances; and (3) develop, implement, and evaluate the efficacy of a proof-of-concept, multi-level structural intervention that integrates reproductive health services into HIV care for HIV+ women and men. The primary outcome at the level of Clinics will be a comparison of changes in the clinic environment and staff attitudes and behaviors regarding the reproductive health of HIV+ persons as perceived by both staff and clients. The primary outcome at the level of Clients among those who wish to avoid childbearing is success in achieving this aim as measured by an algorithm we will develop that will allow us to establish a binary outcome that accounts for the heterogeneity of situations and goals. Among clients who are open to the possibility of childbearing, the "appropriate" outcome will be determined based on a consensus process. Ensuring access to effective contraception, including condoms, is potentially cost-effective as it could reduce unintended pregnancies and maternal morbidity and mortality as well as avert HIV infections in partners and infants at a lower cost than caring for an infected person. If our proof-of-concept (Phase II) trial suggests efficacy, the intervention has the potential for being readily incorporated into the Cape Town metropolitan public health infrastructure and HIV care systems in other countries with emerging AIDS epidemics.

描述（由申请人提供）：在南非，无论是一般的医疗或艾滋病毒特异性治疗的做法，通常解决不一致/未经检测的合作伙伴或并发的艾滋病毒保护需求和生育目标的那些谁是艾滋病毒+的问题。感染艾滋病毒的妇女对避孕和养育子女的选择缺乏足够的信息，艾滋病毒阳性男子的这些需求也没有得到充分满足。无论社会或个人对寻求受孕的艾滋病毒阳性者的健康态度如何，我们从开普敦两家诊所获得的试点数据显示，近50%最近诊断为艾滋病毒阳性的妇女和男子首次获得艾滋病毒护理，他们正在寻求或希望在明年生孩子。迫切需要一个多层次的结构性干预措施，同时解决耻辱和难以获得避孕服务的问题，并引入最佳做法的咨询方法，根据客户的个人情况最大限度地减少性风险。在拟议的研究中，我们将（1）与主要利益相关者进行形成性研究，为制定多层次的结构性干预措施提供信息，将性健康和生殖健康服务纳入艾滋病毒临床护理;（2）开发标准化的咨询算法和决策工具，根据艾滋病毒阳性个体的情况定制安全性行为，避孕和生育信息;以及（3）制定、实施和评估概念验证、多层次结构性干预措施的有效性，该措施将生殖健康服务纳入对艾滋病毒阳性妇女和男子的艾滋病毒护理。诊所一级的主要成果将是比较诊所环境的变化以及工作人员和客户对艾滋病毒阳性者生殖健康的态度和行为。在希望避免生育的人中，客户层面的主要结果是成功实现这一目标，这是通过我们将开发的算法来衡量的，该算法将允许我们建立一个二元结果，该结果将考虑到情况和目标的异质性。在对生育的可能性持开放态度的客户中，“适当”的结果将根据共识过程确定。确保获得有效的避孕药具，包括避孕套，具有潜在的成本效益，因为它可以减少意外怀孕和孕产妇发病率和死亡率，并避免伴侣和婴儿感染艾滋病毒，其成本低于照顾感染者的成本。如果我们的概念验证（II期）试验显示有效性，则该干预措施有可能随时纳入开普敦大都市的公共卫生基础设施和其他艾滋病流行国家的艾滋病毒护理系统。