Asha Improving Health and Nutrition of Indian Women with AIDS and Their Children

阿莎改善印度艾滋病妇女及其子女的健康和营养

• 批准号: 8467393
• 负责人: Maria L. Ekstrand
• 金额: $ 62.75万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-23 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8467393
• 关键词: 8 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anthropometry; Biolectric Impedance; Biological Markers; Body Composition; Car Phone; Caring; Child; Child Care; Cholesterol; Clinical Trials Design; Collaborations; Communities; Computers; Consumption; Data; Data Collection; Development; Diet; Disease Progression; Environment; Face; Family member; Fatty acid glycerol esters; Federal Government; Focus Groups; Food; Food Supplementation; Food Supplements; Funding; Grant; Growth; Growth and Development function; HIV; HIV Seropositivity; Health; Immune; India; Infant; Intake; Intervention; Life; Light; Lipids; Longitudinal Studies; Macronutrients Nutrition; Malnutrition; Measures; Mental Health; Methodology; Methods; Minerals; Mission; Modeling; Monitor; Mothers; Muscle; National Institute of Mental Health; Nutrition Assessment; Nutritional; Nutritional Support; Outcome; Pilot Projects; Pregnant Women; Proteins; Published Comment; Publishing; Recommendation; Relative (related person); Research; Research Personnel; Risk; Rural; Rural Health; Rural Population; Science; Social Work; Supplementation; Technology; Testing; Time; Training; Treatment Protocols; Triglycerides; Underweight; Vitamins; Weight Gain; Wireless Technology; Woman; Women Status; Work; aged; antiretroviral therapy; arm; base; coping; depressive symptoms; design; experience; follow-up; improved; indexing; intervention program; meetings; muscle form; novel; nutrition; nutrition education; physical conditioning; post intervention; primary outcome; programs; public health relevance; scale up; social stigma; therapy adherence; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): Rural women living with AIDS (WLA) in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. Furthermore, they are generally underweight and malnourished, with adherence to antiretroviral therapy (ART) at levels lower than 50%. While the Indian Government's National Rural Health Mission utilizes a successful model to address the health needs of the rural population by training village women as Ashas (Accredited Social Work Activists) to enhance health of pregnant women and their infants, the focus on rural WLA needs to be significantly strengthened. U.S. and Indian collaborators recently completed an R34 pilot study which has demonstrated successful improvement in ART adherence, CD4 levels, and physical and mental health among rural Indian WLA. In total, 34 rural intervention WLA were supported by grant-trained, HIV-focused Ashas who provided assistance to WLA in decreasing barriers to ART adherence and provided protein supplementation compared to equal numbers of usual care WLA who received minimal protein supplementation. While very successful, our Asha pilot study monitored only WLA, despite the fact that many rural children are also at risk for delayed physical growth and psychomotor development. More importantly, we were not able to separate the nutritional component from the care and support component of the Asha, did not incorporate nutritional biomarkers, and were limited by only a six-month follow-up. In light of the mandate to advance both the science of nutrition and sustainability in real settings, our experienced team proposes to build on and extend our successful pilot work to meet this need, by assessing the incremental advantages of nutritional support to Asha care and support alone, and the impact of these programs on an index child (oldest between 3-8 years). In addition, we will take advantage of rural India's excellent mobile phone coverage and computer technology for both wireless data collection and data transfer. The proposed longitudinal study will use a 2x2 factorial design, specifically, 1) Asha support alone for WLA , vs. 2) Asha support for WLA + nutrition (food-based) training, vs. 3) Asha support for WLA + food supplementation, vs. 4) Asha support for WLA + nutrition training + food supplementation, to test the effects of nutrition training and/or food supplementation on primary outcomes of anthropometric parameters and immune status (CD4 levels) of the WLA at 6-, 12- and 18-month follow-up; and secondarily on ART adherence, psychological health, nutritional adequacy and lipid status of the WLA over time. Based upon reviewers' comments, among index children, we streamlined our assessments to include anthropometric parameters and psychomotor development; and among those HIV positive, immune status.

描述（由申请人提供）：印度农村艾滋病妇女（WLA）在获得和遵循治疗方案、照顾家庭成员和保持积极的心理健康方面继续面临深刻的挑战。此外，他们普遍体重不足，营养不良，坚持抗逆转录病毒疗法的比例低于50%。虽然印度政府的国家农村保健使命采用了一个成功的模式，通过培训农村妇女成为经认可的社会工作积极分子来满足农村人口的保健需要，以增进孕妇及其婴儿的健康，但需要大力加强对农村妇女解放协会的重视。美国和印度的合作者最近完成了一项R34试点研究，该研究成功地改善了印度农村WLA的抗逆转录病毒治疗依从性、CD 4水平以及身心健康。总共有34个农村干预工作的妇女LA得到了赠款培训的、以艾滋病毒为重点的Asha的支持，Asha向妇女LA提供援助，减少坚持抗逆转录病毒疗法的障碍，并提供蛋白质补充剂，相比之下，同样数量的通常护理工作的妇女LA只接受最低限度的蛋白质补充剂。我们的阿莎试点研究虽然非常成功，但只监测了妇女生活水平，尽管许多农村儿童也面临身体发育和心理发育迟缓的风险。更重要的是，我们无法将阿莎的营养成分与护理和支持成分分开，没有纳入营养生物标志物，并且仅限于6个月的随访。鉴于在真实的环境中推进营养科学和可持续性的任务，我们经验丰富的团队建议通过评估营养支持对阿莎单独护理和支持的增量优势，以及这些计划对索引儿童（年龄在3-8岁之间）的影响，建立并扩展我们成功的试点工作，以满足这一需求。此外，我们将利用印度农村地区良好的移动的电话覆盖和计算机技术进行无线数据收集和数据传输。拟定的纵向研究将使用2x2析因设计，具体而言，1）WLA仅支持阿莎，对比2）WLA +营养支持阿莎（基于食物的）培训，对比3）阿莎对妇女解放军+食物补充的支持，对比4）阿莎对妇女解放军+营养培训+食物补充的支持，测试营养训练和/或食物补充对人体测量参数和免疫状态的主要结果的影响（CD 4水平）的WLA在6个月，12个月和18个月的随访;其次是ART坚持，心理健康，营养充足性和脂质状态的WLA随着时间的推移。根据评论者的评论，在指标儿童中，我们简化了我们的评估，包括人体测量参数和精神运动发育;在艾滋病毒阳性儿童中，包括免疫状态。