Validation of a community survey methodology for measuring PMTCT impact

验证衡量预防母婴传播影响的社区调查方法

• 批准号: 8434398
• 负责人: Benjamin H. Chi
• 金额: $ 45.42万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-25 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8434398
• 关键词: Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; African; Age-Months; Agreement; Award; Caring; Characteristics; Child; Collaborations; Communities; Community Surveys; Consensus; Country; Data; Data Collection; Demographic and Health Surveys; Enrollment; Epidemic; Equipment and supply inventories; Evaluation; Foundations; Funding; Goals; Gold; HIV; Health; Health Services; Household; Impact evaluation; Individual; Infant; Infectious Diseases Research; International; Investments; Knowledge; Lead; Measurement; Measures; Medical; Mentorship; Methodology; Methods; Metric; Modeling; Monitor; Mothers; Newborn Infant; Outcome; Outcome Measure; Patient Care; Patients; Policies; Population; Positioning Attribute; Prevention; Prevention Guidelines; Prevention approach; Process; Program Effectiveness; Program Evaluation; Prophylactic treatment; Quality of Care; Recommendation; Reporting; Research; Research Infrastructure; Resources; Role; Rural; Rural Health; Sampling; Standardization; Survey Methodology; Surveys; Time; Validation; Work; World Health Organization; Zambia; cohort; cost effective; design; experience; implementation science; improved; infant outcome; innovation; pediatric AIDS; pediatric human immunodeficiency virus; prevent; prevention service; programs; response; service utilization; success; transmission process

DESCRIPTION (provided by applicant): A key gap in prevention of mother-to-child HIV transmission (PMTCT) implementation science is the lack of validated approaches to measure program effectiveness. Although this need has been recognized for years, it has come to the forefront with the 2011 launch of the "eliminating mother-to-child HIV transmission" (EMTCT) campaign by UNAIDS, PEPFAR, and other global partners. Alongside ambitious goals to dramatically reverse the pediatric AIDS epidemic, EMTCT calls for new measures to define program success. Traditional metrics such as program coverage have been replaced with direct health outcomes such as HIV-free survival, an important paradigm shift that will require new and innovative evaluation approaches. The World Health Organization is currently developing guidelines for PMTCT evaluation and among their recommended methodologies is a community survey. Strengths of the survey approach are its population-level sampling, an ability to measure HIV-free survival, a cross-sectional design with retrospective data collection, and the ease with which it could be incorporated into ongoing nationwide initiatives (e.g., Demographic and Health Surveys). However, potential ascertainment and reporting biases could lead to inaccurate results. If this methodology is to be recommended for broader implementation, a formal validation is urgently needed. To address this important knowledge gap, a two-part study is proposed. First, a community survey methodology will be validated against a "gold standard" community cohort design. In support of this aim, retrospective community survey data from 10,500 households across 42 communities (250 per community) involved in the ongoing Better Health Outcomes through Mentorship and Assessment (BHOMA) study will be used to calculate HIV- free survival in HIV-exposed children at 18 months of age. In parallel, 1,680 HIV-exposed newborns will be enrolled in cohorts across the same communities (40 per community) and followed prospectively for 18 months. Measurements of HIV-free survival from the two methodologies will be compared, and the validity of the survey approach determined. Second, program characteristics and practices associated with improved PMTCT outcomes will be identified by collecting facility-level data-including direct observations of patient care, assessment of patient encounter times, and supply inventory levels-and correlating them with community- level HIV-free survival from both the survey and cohort methodologies. In this manner, the study will identify "best practices" for PMTCT and potentially generate new scientific questions for interventional research, a key function of implementation science within PEPFAR's framework. The results from the study are expected to have a direct impact on PMTCT program evaluation in Zambia and immediately inform monitoring and evaluation policy recommendations globally. PUBLIC HEALTH RELEVANCE: Programs to prevent mother-to-child HIV transmission (PMTCT) have successfully and rapidly expanded across sub-Saharan Africa; however, approaches for measuring their impact lack consensus and standardization. We seek to validate a community survey methodology for estimating HIV-free survival among HIV-exposed infants at a population level, comparing our measurement against that of a "gold standard" cohort design. Our results will have an immediate impact on regional and international policy recommendations by helping to establish a rigorous evaluation framework for pediatric HIV elimination.

描述（由申请人提供）：预防母婴艾滋病毒传播（PMTCT）实施科学的一个关键差距是缺乏有效的方法来衡量计划的有效性。尽管多年来人们已经认识到这一需要，但随着2011年联合国艾滋病规划署、总统艾滋病紧急救援计划和其他全球合作伙伴发起的“消除母婴艾滋病毒传播”运动，这一需要已成为最重要的问题。除了大幅度扭转儿科艾滋病流行的雄心勃勃的目标外，EMTCT还呼吁采取新的措施来确定项目的成功。传统的衡量标准，如方案覆盖率，已被直接的健康结果所取代，如无艾滋病毒生存率，这是一个重要的范式转变，需要新的和创新的评估方法。世界卫生组织目前正在制定预防母婴传播评估准则，其建议的方法之一是社区调查。调查方法的优势在于其人口水平的抽样，衡量无艾滋病毒生存率的能力，具有回顾性数据收集的横断面设计，以及易于将其纳入正在进行的全国性倡议（例如，人口和健康调查）。然而，潜在的确定和报告偏差可能导致不准确的结果。如果要建议更广泛地实施这一方法，就迫切需要进行正式验证。为了解决这一重要的知识差距，提出了一个两部分的研究。首先，将根据“黄金标准”社区队列设计验证社区调查方法。为了支持这一目标，将使用来自42个社区（每个社区250个）10，500个家庭的回顾性社区调查数据，这些家庭参与正在进行的通过指导和评估改善健康结果（BHOMA）研究，以计算18个月大的艾滋病毒暴露儿童的无艾滋病毒生存率。与此同时，1,680名艾滋病毒暴露的新生儿将被纳入同一社区的队列（每个社区40名），并前瞻性随访18个月。将比较两种方法对无艾滋病毒生存率的测量，并确定调查方法的有效性。其次，通过收集机构层面的数据（包括对患者护理的直接观察、对患者就诊时间的评估和供应库存水平），并将其与来自调查和队列方法的社区层面无艾滋病毒生存率相关联，确定与改善预防母婴传播结局相关的项目特征和实践。通过这种方式，这项研究将确定防止母婴传播的“最佳做法”，并可能为干预性研究提出新的科学问题，这是总统艾滋病紧急救援计划框架内执行科学的一项关键职能。研究结果预计将对赞比亚预防母婴传播方案的评价产生直接影响，并立即为全球监测和评价政策建议提供信息。 公共卫生相关性：预防母婴艾滋病毒传播的方案已成功地迅速扩展到整个撒哈拉以南非洲;然而，衡量其影响的方法缺乏共识和标准化。我们试图验证一个社区调查方法，估计艾滋病毒暴露的婴儿在人口水平的无艾滋病毒生存，比较我们的测量与“金标准”队列设计。我们的研究结果将对区域和国际政策建议产生直接影响，帮助建立一个严格的儿科艾滋病毒消除评估框架。