Optimizing integrated PMTCT services in rural North-Central Nigeria

说明(申请人提供)：在资源有限的情况下，扩大预防艾滋病毒母婴传播服务(母婴传播)的进展继续落后于世界其他地区。尼日利亚是世界上艾滋病毒母婴传播负担最高的国家之一。要在尼日利亚消除艾滋病毒的母婴传播，就需要在保健系统的最低一级采用创新的预防母婴传播服务提供方法，同时提供适当、可行和有效的护理。这项研究的目标是实施和评估以家庭为重点的综合预防母婴传播一揽子计划的影响，该计划包括任务转移、照顾点CD4测试以及有影响力的家庭成员(特别是男性伴侣)在尼日利亚农村初级卫生中心的突出作用。这项研究的具体目的是：(1)评估在初级产前诊所实施综合预防母婴传播一揽子计划是否增加了为预防母婴传播而开始抗逆转录病毒药物治疗的合格孕妇的比例；(2)确定实施预防母婴传播一揽子计划是否改善了产后母婴对6周的滞留；以及(3)与现有的标准护理转诊模式相比，对这种新的预防母婴传播干预措施的影响进行了成本-效果分析。我们组建了一支由尼日利亚和美国科学家组成的强大团队，他们在预防母婴传播群组随机试验、坚持和保留护理、艾滋病毒风险行为、CART结果以及艾滋病毒项目的成本效益分析方面拥有专业知识。我们包括严格的研究设计和数据收集方法(定量结果、成本效益分析、定性调查)的三角测量，以产生有价值的补充数据。我们将建立在现有的国内PEPFAR基础设施、已建立的伙伴关系和强大的当地存在的基础上，从而增加成功实施研究的可能性。 公共卫生相关性：这种扩大预防母婴传播服务提供的创新方法，如果被证明是可行和有效的，将被用于PEPFAR计划，以加快消除艾滋病毒母婴传播和帮助感染艾滋病毒的妇女长寿、健康生活的进展。这项R01提案的目的是评估以家庭为重点的综合预防艾滋病毒母婴传播一揽子计划的影响和成本效益，其中包括将预防母婴传播服务(包括抗逆转录病毒治疗)的任务转移给低层干部工人，采用照顾点CD4检测，以及让尼日利亚农村有影响力的艾滋病毒感染母亲的家庭成员发挥突出作用。这种扩大预防母婴传播服务提供的创新方法，如果被证明是可行和有效的，将被用于PEPFAR计划，以加快在消除艾滋病毒母婴传播和帮助感染艾滋病毒的妇女长寿、健康生活方面的进展。

DESCRIPTION (provided by applicant): In resource-limited settings progress in scaling up services for prevention of mother-to-child transmission of HIV (PMTCT) continues to lag behind the rest of the world. Nigeria has one of the highest burdens of mother-to-child transmission of HIV in the world. The elimination of mother-to-child transmission of HIV in Nigeria will require innovative methods of PMTCT service delivery at the lowest level of the health care system, consistent with appropriate, feasible and effective care. The goal of this study is to implement and evaluate the impact of a family- focused integrated PMTCT package comprising task shifting, point-of-care CD4 testing, and a prominent role for influential family members (particularly male partners) in rural primary health centers in Nigeria. The specific aims of this study are: (1) To evaluate whether implementation of the integrated PMTCT package in primary level antenatal clinics increases the proportion of eligible pregnant women who initiate antiretroviral medications for the purposes of PMTCT; (2) To determine whether implementation of the PMTCT package improves postpartum retention of mother-infant pairs at 6 weeks; and (3) Conduct a cost-effectiveness analysis of the impact of this novel PMTCT intervention compared to the existing standard-of-care referral model. We have assembled a strong team of Nigerian and American scientists with expertise in PMTCT cluster randomized trials, adherence and retention in care, HIV risk behavior, cART outcomes, and cost-effectiveness analysis of HIV programs. We include a rigorous study design and triangulation of data collection methods (quantitative outcomes, cost effectiveness analysis, qualitative surveys) that will yield valuable complimentary data. We will build on existing in- country PEPFAR infrastructure, established partnerships, and strong local presence, thereby increasing the likelihood of successful study implementation. PUBLIC HEALTH RELEVANCE: This innovative approach to scaling up PMTCT service provision, if proven feasible and effective, will be adopted in PEPFAR programs to accelerate progress toward eliminating mother-to-child transmission of HIV and helping women with HIV infection live long, healthy lives. The purpose of this R01 proposal is to evaluate the impact and cost-effectiveness of a family-focused integrated prevention of mother-to-child transmission of HIV (PMTCT) package comprising task shifting of PMTCT services (including antiretroviral therapy) to lower-cadre workers, adoption of point-of-care CD4 testing, and a prominent role for influential family members of HIV-infected mothers in rural Nigeria. This innovative approach to scaling up PMTCT service provision, if proven feasible and effective, will be adopted in PEPFAR programs to accelerate progress toward eliminating mother-to-child transmission of HIV and helping women with HIV infection live long, healthy lives.