HIV and Perinatal Depression in Brazil

巴西的艾滋病毒和围产期抑郁症

• 批准号: 7489669
• 负责人: Judith Karen Bass
• 金额: $ 13.5万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7489669
• 关键词: AIDS/HIV problem; Address; Adjustment Disorders; Anti-Retroviral Agents; Antiretroviral resistance; Anxiety; Anxiety Disorders; Area; Biomedical Research; Brain Diseases; Brazil; Caring; Child; Child Care; Chronic; Clinic; Clinical; Collection; Communities; Complex; Comprehensive Health Care; Condition; Consequences of HIV; Data; Depression screen; Depressive disorder; Developed Countries; Developing Countries; Development; Diagnostic; Disease; Effectiveness; Enrollment; Ensure; Epidemic; Etiology; Event; Faculty; Failure to Thrive; Female of child bearing age; Frequencies; Funding; Future; Grant; HIV; HIV Infections; HIV Seropositivity; Health; Hookworms; Hospitals; Human Milk; Immunization; Immunologics; Individual; Infant Health; Infection; International; Intervention; Intervention Studies; Language; Latin America; Life; Major Depressive Disorder; Malaria; Maternal Health; Maternity Hospitals; Measures; Medical; Medicine; Mental Depression; Mental Health; Mental disorders; Morbidity - disease rate; Mothers; NIH Program Announcements; National Institute of Mental Health; Nature; Neurobiology; Neurocognitive; Newborn Infant; Numbers; Outcome; Patients; Perinatal; Perinatal Epidemiology; Personal Satisfaction; Pharmaceutical Preparations; Policies; Population; Population Study; Postpartum Depression; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Prevalence; Prevalence Study; Prevention; Program Development; Psychosocial Factor; Psychotic Disorders; Public Health; Randomized Controlled Trials; Range; Rate; Recruitment Activity; Relative (related person); Reporting; Research; Research Design; Research Infrastructure; Research Personnel; Research Project Grants; Resistance; Risk; Risk Factors; Sampling Studies; Schedule; Screening procedure; Second Pregnancy Trimester; Site; Social Aspects of Cancer; Social support; Source; Stigmata; Stress; Structure; Supplementation; Support System; Symptoms; Target Populations; Terminology; Testing; Time; Treatment Efficacy; Treatment Protocols; Tuberculosis; United States; United States National Institutes of Health; Universities; Upper arm; Validation; Vertical Disease Transmission; Viral; Virus; Visit; Woman; World Health Organization; antiretroviral therapy; base; concept; coping; cost; depressive symptoms; design; early childhood; improved; instrument; intervention program; low socioeconomic status; multidisciplinary; perinatal intervention; prenatal; programs; prospective; psychologic; psychosocial; single episode major depressive disorder; social stigma; stressor; tool; transmission process; treatment program

DESCRIPTION (provided by applicant): Given the high global co-morbidity of HIV and major depressive disorder (MDD), understanding the negative synergistic effects of these two disabling conditions is increasingly important as comprehensive HIV care moves beyond biomedical concerns to include concurrent treatment of mental disorders. Our long-term research program uses perinatal depression (PD) in HIV-infected mothers in southern Brazil as an initial paradigm for intervention studies of the interaction of HIV and MDD. Brazil offers several major advantages for conducting prospective, focused, straight-forward studies of this complex global problem: > 98% of pregnant women receive free effective HIV-treatment; mother-to-child HIV transmission rates are <1%; integration of our research program with a large, well-established and successful NICHD-funded program (International Site Development Initiative - NISDI) that seeks to strengthen biomedical research infrastructure for studying HIV-infected women and their newborn children in Latin America; and a highly centralized HIV treatment program for pregnant women, providing access to large numbers of HIV-infected women presenting for care early in their pregnancies. Our R21 application is a segue to an eventual R01 application for a large multi-arm randomized controlled trial of interventions for treatment of PD among women undergoing effective ARV treatment. This present bi-national, multidisciplinary project will enable collection of requisite pilot data on prevalence of PD, identification of risk factors and leverage points for subsequent intervention programs, development of effective strategies for integration of studies of PD into NISDI, and adaptation and validation of screening instruments among the local population. Using the NISDI infrastructure at the Faculty of Medicine, University of Caxias in southern Brazil we will conduct interconnected studies in Porto Alegre (population ~10 million) during the 24-month study period. Study 1: a qualitative study to delineate local concepts of depression, coping strategies, social support, and stigma; and Studies 2 and 3: PD screenings among 450 HIV-infected and 450 control HIV-uninfected women at two time points (during the second trimester of pregnancy and three-four months post-partum) at two large Brazilian Federation hospitals to establish PD prevalence rates and increase understanding of the impact of associated psychosocial factors (frequency of stressful life events, support systems, coping and stigma). We seek to use the high proclivity for seeking prenatal care and newborn health visits that frequently characterizes an often marginalized HIV-infected population of women who may otherwise not be available for study. We hope to use this opportunity to develop effective screening and sustainable PD intervention programs at a time when changes in global and national HIV policies will render such tools of increasing importance to comprehensive care of HIV. PUBLIC HEALTH RELEVANCE: Currently we know little about the nature of depression among HIV-infected women of child-bearing age; particularly in the context of effective HIV treatment programs, which are allowing infected women to live longer and significantly reducing mother-to-child transmission of the virus. This research will begin to address this issue by studying the nature, importance and causes of perinatal depression related to HIV infection and will be used to develop feasible and sustainable options for treating perinatal depression whose efficacy will be tested in a future grant submission.

描述（由申请人提供）：鉴于HIV和重度抑郁症（MDD）的全球合并症很高，因此了解这两种残疾疾病的负面协同作用越来越重要，因为全面的HIV护理移动超出了生物医学关注，包括对精神障碍的同时治疗。我们的长期研究计划在巴西南部的HIV感染母亲中使用围产期抑郁症（PD），作为对HIV和MDD相互作用的干预研究的初步范式。巴西为对这一复杂的全球问题进行前瞻性，集中，直接的研究提供了几个主要优势：> 98％的孕妇获得免费的有效HIV治疗；母子艾滋病毒传播率<1％；将我们的研究计划与大型，建立良好和成功的NICHD资助计划（国际场地开发计划-NISDI）的整合，该计划旨在加强在拉丁美洲研究HIV感染的妇女及其新生儿的生物医学研究基础设施；以及针对孕妇的高度集中式艾滋病毒治疗计划，为在怀孕初期提供护理的大量艾滋病毒感染的妇女提供了机会。我们的R21应用是最终的R01应用程序，用于在接受有效ARV治疗的妇女中进行大型多臂随机对照试验，以治疗PD。目前的本国跨学科项目将促进有关PD患病率的必要试点数据，识别风险因素并利用了随后的干预计划的利用点，开发了将PD研究整合到NISDI中的有效策略，以及适应和验证当地人群中的筛查工具。在巴西南部的卡克西亚大学医学院使用NISDI基础设施，我们将在24个月的研究期间在Porto Alegre（人口约1000万）进行互连研究。研究1：一项定性研究，以描绘抑郁症，应对策略，社会支持和污名的当地概念；和研究2和3：在两个大型巴西联邦医院，在两个时间点（在怀孕的第二个三个月和三个月后三个月内）在450名HIV感染和450个对照HIV未感染的妇女中进行了PD筛查，以建立PD的PD患病率，并建立PD的患病率，并增加对压力生活的相关心理因素的影响（频率），支持系统，支持系统，认可和St. copig and copig和St.我们试图利用高倾向来寻求产前护理和新生儿健康就诊，这些访问经常表征经常被边缘化的艾滋病毒感染的妇女人群，否则这些妇女可能无法进行研究。我们希望在全球和国家艾滋病毒政策的变化将使此类工具对艾滋病毒的全面护理中提高这种工具，以开发有效的筛查和可持续的PD干预计划。 公共卫生相关性：目前，我们对育儿年龄的艾滋病毒感染妇女的抑郁症的性质知之甚少；特别是在有效的艾滋病毒治疗计划的背景下，该计划使感染妇女能够寿命更长，并显着减少病毒的母亲传播。这项研究将通过研究与艾滋病毒感染有关的围产期抑郁症的性质，重要性和原因来解决这一问题，并将用于开发可行且可持续的选择，用于治疗围产期抑郁症，这些抑郁症的功效将在未来的赠款提交中进行测试。