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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

基本信息

批准号：
8037580
负责人：
Joanne Ellen Mantell
金额：
$ 18.85万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-03-01 至 2013-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8037580
关键词：
Accounting Acquired Immunodeficiency Syndrome Address African Algorithms Attitude Behavior Belief Biological Caring Child Cities Client Clinic Conceptions Consensus Contraceptive Agents Contraceptive methods Counseling Country Data Decision Making Developing Countries Development Diagnosis Economics Ensure Environment Epidemic Failure Family Planning Family Planning Personnel Family Practice Female Condoms Fertility Goals Guidelines HIV HIV Infections HIV Seropositivity HIV diagnosis HIV prevention trial HIV/STD Health Health Policy Heterogeneity Individual Infant Infection International Intervention Interview Lead Life Male Condoms Measures Medical Modeling Morbidity - disease rate NIH Office of AIDS Research Outcome Outcome Assessment Parenting behavior 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 Sexual Health Site South Africa Staff Attitudes Stigmata Testing Time Translations Treatment Efficacy Universities Unsafe Sex Vertical Disease Transmission Weight Woman Work base care systems child bearing clinical care condoms cost cost effective cultural values experience follow-up indium arsenide informant innovation men metropolitan mortality pregnancy prevention pregnant pressure prevent primary outcome safer sex social social stigma standard of care success therapy design tool unintended pregnancy

项目摘要

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，一般医疗和艾滋病毒专门治疗做法都没有常规地解决不一致/未经检测的伴侣的问题，也没有同时解决艾滋病毒感染者的艾滋病毒保护需求和生育目标。感染艾滋病毒的妇女对避孕和养育子女的选择了解不足，而这些需求在感染艾滋病毒的男子中得不到充分满足。无论社会或个人对艾滋病毒阳性患者寻求怀孕的正确性的态度如何，我们来自开普敦两家诊所的试点数据显示，近50%的新近诊断为艾滋病毒阳性的妇女和男子第一次获得艾滋病毒护理，他们正在寻求或希望在明年生孩子。迫切需要采取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，并根据客户的个人情况引入最佳实践咨询方法，最大限度地降低性风险。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，为将性健康和生殖健康服务纳入艾滋病毒临床护理的多层次结构性干预提供信息；(2)开发标准化的咨询算法和决策工具，根据HIV+个体的情况量身定制安全性行为、避孕和生育信息；(3)制定、实施并评估一项概念验证的多层次结构性干预措施的效果，该措施将生殖健康服务纳入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和工作人员对工作人员和客户所认为的艾滋病毒感染者生殖健康的态度和行为的变化。在那些希望避免生育的客户中，主要结果是成功实现这一目标，通过我们将开发的算法来衡量，该算法将允许我们建立一个二元结果，该结果考虑了情况和目标的异质性。在对生育可能性持开放态度的客户中，“适当”的结果将根据协商一致的过程确定。确保获得有效避孕，包括避孕套，可能具有成本效益，因为它可以减少意外怀孕和孕产妇发病率和死亡率，并以比照顾感染者更低的成本避免伴侣和婴儿感染艾滋病毒。如果我们的概念验证（II期）试验表明有效，那么该干预措施有可能被纳入开普敦大都会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。