Perinatal Depression, Stigma, Social Capital Utilization and PMTCT Adherence

围产期抑郁、耻辱、社会资本利用和 PMTCT 依从性

• 批准号: 8263521
• 负责人: Christina Psaros
• 金额: $ 17.15万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8263521
• 关键词: AIDS prevention; Academic Training; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Africa; Africa South of the Sahara; Age; Area; Award; Behavior; Behavior Therapy; Biometry; Child; Child health care; Childhood; Chronic Disease; Clinic; Clinical; Communities; Complement; Counseling; Data; Developing Countries; Development; Enrollment; Epidemic; Epidemiology; Face; Faculty; General Hospitals; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Health behavior; Healthcare; Individual; Infant; Infant Mortality; Infection; International; Intervention; K-Series Research Career Programs; Left; Life; Massachusetts; Maternal Health; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Mothers; Outcome; Pathway interactions; Pattern; Perinatal; Personal Satisfaction; Play; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Labor; Preventive Intervention; Problem behavior; Protocols documentation; Province; Psychologist; Public Health Schools; Reproductive Health; Research; Research Activity; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Review Literature; Risk Behaviors; Role; Series; Services; Social Network; South Africa; Statistical Methods; Stigmata; Structure; Techniques; Testing; Time; Training; Uganda; United Nations; Universities; Ursidae Family; Vertical Disease Transmission; Woman; Women' s Health; Work; antiretroviral therapy; base; burden of illness; career; disturbance in affect; experience; improved; innovation; interest; mathematical model; medical schools; meetings; mortality; novel; patient oriented research; prevent; programs; reproductive; social; social capital; social stigma; success; therapy adherence; therapy development; transmission process

DESCRIPTION (provided by applicant): The United Nations Millennium Development Goals (MDGs) illustrate key areas in which the lives of women and children worldwide are in need, including improving maternal health and a reduction in childhood mortality. The success of meeting both these goals depends on reducing rates of vertical transmission of HIV. Sub-Saharan Africa is one of the areas targeted by the MDGs and bears a substantial degree of HIV disease burden, with well over 22 million people living with HIV at the end of 2008, a significant number of whom are women of reproductive age. Depression has been associated with non-adherence to the series of health behaviors known as preventing mother-to-child transmission (PMTCT) of HIV. Women in resource limited settings are likely to face additional barriers to PMTCT adherence, including stigma and structural barriers. While structural barriers may be circumvented by relying on community resources (known as social capital), depression and stigma may make it difficult to access these resources. Thus, understanding the role of modifiable factors that contribute to PMTCT adherence is critical to meeting the goals of the MDGs. Candidate: I am a clinical psychologist and recently transitioned to faculty at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain training and mentorship in order to become an independent investigator at the R01 level, and an expert in depression and adherence to health behaviors important to the health of HIV infected women in resource limited settings. Mentoring: Both my primary mentor (Safren) and co-mentor (Bangsberg) have protected time to devote to my mentorship via K24 Mid-Career Investigator Awards in Patient-Oriented Research. Both are experts in the field of antiretroviral therapy adherence in international settings. Dr. Safren is aso an expert in depression and behavioral intervention development. In addition, I have assembled a team of consultants with expertise in other critical aspects of my proposal, including women's reproductive health (Smit), PMTCT (Peltzer), stigma (Kalichman), social networks and health (Christakis), and biostatistics (Ghebremichael). Research: The goals of the proposed project are to (1) investigate the relationships among perinatal depression, stigma, social capital utilization PMTCT adherence, and (2) to test a pilot intervention to treat perinatal depression and improve adherence to ARVs among HIV infected women in a resource limited setting. Training: My research activities will be supported by structured meetings with my mentors and coursework in advanced statistical methods, psychiatric epidemiology, and healthcare in developing countries at the Harvard School of Public Health, the timing of which will complement my proposed research activities. My exceptional mentoring team, strong institutional support, innovative research questions, and my commitment to addressing issues relevant to the health of HIV infected women and their children leave me well positioned to achieve my goal of becoming an independent investigator. PUBLIC HEALTH RELEVANCE: While approximately 40,000 children become infected with HIV in South Africa alone each year, transmission of HIV from mother to infant can be reduced dramatically through a variety of techniques known as "PMTCT" (preventing mother to child transmission). Not all women complete appropriate PMTCT protocols and factors such as stigma and depression may play a significant role in non-adherence. Mathematical modeling studies have proposed that without increasing rates of adherence to these protocols, we will not see significant reductions in mother-to-child HIV transmission and therefore cannot reduce rates of infant mortality; thus, identifying the role of and intervening upon modifiable pathways of non-adherence is critical.

描述（由申请人提供）：联合国千年发展目标（MDGS）说明了全世界妇女和儿童生活的关键领域，包括改善孕产妇健康和降低儿童死亡率。实现这两个目标的成功取决于降低艾滋病毒垂直传播的速度。撒哈拉以南非洲是千年发展目标的目标之一，承担着巨大的艾滋病毒疾病负担，截至2008年底，艾滋病毒感染了2200万人，其中大量是生殖年龄的妇女。抑郁症与称为防止艾滋病毒母亲到孩子传播（PMTCT）的一系列健康行为有关。在资源有限的环境中，妇女可能会面临PMTCT依从性的其他障碍，包括污名和结构障碍。尽管依靠社区资源（称为社会资本）可能会规避结构性障碍，但抑郁症和污名可能使得获得这些资源变得困难。因此，了解有助于PMTCT依从性的可修改因素的作用对于满足MDG的目标至关重要。候选人：我是一名临床心理学家，最近过渡到马萨诸塞州综合医院/哈佛医学院的教师。我正在申请五年的K23职业发展奖，以获得培训和指导，以成为R01级别的独立研究者，并且是抑郁症和对健康行为的专家，对在资源有限的环境中对HIV感染妇女的健康很重要。指导：我的主要导师（Safren）和同事（Bangsberg）都保护了时间，以通过K24中级研究员奖在以患者为导向的研究中致力于我的指导。两者都是国际环境中抗逆转录病毒治疗领域的专家。 Safren博士是抑郁和行为干预发展的专家。此外，我还召集了一组顾问团队，这些顾问在我的提案的其他关键方面具有专业知识，包括妇女生殖健康（SMIT），PMTCT（Peltzer），污名（Kalichman），社交网络和健康（Christakis）以及生物统计学（Ghebremichael）。研究：拟议项目的目标是（1）调查围产期抑郁症，污名，社会资本利用PMTCT依从性的关系，以及（2）测试试点干预以治疗围产期抑郁症并改善在资源有限的环境中艾滋病毒感染妇女中ARV的遵守。培训：我的研究活动将得到与我的导师的结构化会议，并在哈佛大学公共卫生学院的发展中国家的高级统计方法，精神病学流行病学和医疗保健方面的结构化会议支持，其时机将补充我建议的研究活动。我的卓越指导团队，强大的机构支持，创新的研究问题以及我致力于解决与艾滋病毒感染妇女及其子女健康有关的问题的承诺，使我有好处，以实现成为独立研究者的目标。 公共卫生相关性：虽然每年仅在南非就有大约40,000名儿童感染了艾滋病毒，但通过多种称为“ PMTCT”（阻止母亲到传播儿童）的技术，可以大大减少艾滋病毒到婴儿的艾滋病毒传播。并非所有妇女都填写适当的PMTCT方案和污名和抑郁等因素可能在不遵守中起重要作用。数学建模研究提出，如果没有增加对这些方案的遵守率，我们将看不到母亲到孩子的艾滋病毒传播的大幅降低，因此无法降低婴儿死亡率。因此，确定不遵守可修改途径的作用和介入的作用至关重要。