Impact and Cost-effectiveness of Safer Conception Strategies for HIV Prevention

预防艾滋病毒的安全受孕策略的影响和成本效益

• 批准号: 8541534
• 负责人: Joelle Morgan Brown
• 金额: $ 17.99万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541534
• 关键词: AIDS prevention; Academic Training; Accounting; Address; Adherence; Adult; Affect; Africa South of the Sahara; African; Age; Award; Breast Feeding; Caring; Child; Clinic; Clinical; Conceptions; Country; Couples; Data; Educational workshop; Effectiveness of Interventions; Equipment; Evaluation; Face; Family Planning; Future; Goals; Guidelines; HIV; HIV Infections; Individual; Intervention; Intervention Trial; K-Series Research Career Programs; Kenya; Knowledge; Laboratories; Lead; Literature; Measurement; Measures; Mentors; Mentorship; Methodology; Methods; Modeling; Outcome; Patients; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Pregnancy; Prevention; Prevention Research; Prevention strategy; Preventive Intervention; Process; Provider; Province; Public Health; Publishing; Randomized; Reproductive Health; Research; Research Personnel; Research Project Grants; Resources; Risk; Series; Services; Sex Behavior; Societies; Surveys; Testing; Time; Time and Motion Studies; Training; United States National Institutes of Health; Vertical Disease Transmission; Work; career; cohort; condoms; cost; cost effective; cost effectiveness; design; effective intervention; evidence based guidelines; experience; improved; neglect; preference; prevent; programs; public health relevance; reproductive; response; scale up; transmission process; uptake

DESCRIPTION (provided by applicant): Impact and Cost-effectiveness of Safer Conception Strategies for HIV prevention This mentored research project will investigate an urgent public health problem that has been neglected in HIV prevention research: the reproductive needs of HIV-discordant couples who desire pregnancy. Across sub-Saharan Africa, the vast majority of HIV-infected individuals are adults of reproductive age. The HIV prevention literature has almost exclusively focused on strategies to prevent sexual HIV transmission in the context of promoting 100% condom use, which is not compatible with conception, and strategies to prevent HIV after conception has occurred, e.g., prevention of transmission from mother to child during pregnancy, labor and delivery, or breastfeeding. While several reviews on safer conception and HIV prevention have been published and clinical guidelines have recently been developed, there has been no systematic research to examine the costs, potential impact and cost-effectiveness, or actual preferences for different strategies of safer conception. My proposed mentored research plan will address this critical gap in HIV prevention research. It is comprised of two phases: the first phase a small mixed methods demonstration project to pilot test the safer conception guidelines in Kenya; and the second, a study to estimate costs and model the potential impact and cost- effectiveness of the guidelines.These phases will address the following aims: (1) Conduct a mixed-methods demonstration project to (i) characterize adherence to and preferences for different safer conception strategies, and (ii) estimate parameters necessary to model the impact of and design a large-scale evaluation of a combination safer conception program in this setting. I will, with a Kenyan research team, use quantitative and qualitative methodologies to characterize uptake, adherence to, and patient and provider preferences for different safer conception strategies, and generate critical preliminary estimates of process and impact outcomes, and inter-clinic variability in outcomes. The findings from this work will lay the groundwork for Aims 2 and 3; (2) Estimate the cost, and model the impact and cost-effectiveness of different strategies for safer conception for HIV-discordant couples in Nyanza Province, Kenya. I will carry out "micro- costing" and time and motion studies during the implementation of the demonstration project (above) to gather estimates on resources required for providing safer conception options. I will use data from the demonstration project and appropriate historical cohorts to model the potential impact and cost-effectiveness of different strategies of safer conception interventions for HIV prevention among discordant couples in this setting; (3) Develop a preliminary plan for a combination safer conception intervention to prevent HIV transmission among HIV discordant couples in Nyanza. In participatory workshops with local stakeholders, we will critically evaluate the research findings, identify potential challenges, define the safer conception intervention package, and develop an intervention plan. In year 4, I will submit an R-series application to the NIH for a large-scale study to determine the impact and estimate the cost-effectiveness of the intervention.

描述（由申请人提供）：艾滋病毒预防更安全的概念策略的影响和成本效益这个指导研究项目将调查一个紧迫的公共卫生问题，已被忽视的艾滋病毒预防研究：艾滋病毒不和谐的夫妇谁希望怀孕的生殖需求。在整个撒哈拉以南非洲，绝大多数艾滋病毒感染者是育龄成年人。艾滋病毒预防文献几乎完全集中于在促进100%使用避孕套的情况下预防性传播艾滋病毒的战略，这与怀孕不相容，以及在怀孕后预防艾滋病毒的战略，例如，在怀孕、分娩和分娩期间或母乳喂养期间预防母婴传播。虽然已经发表了几篇关于安全受孕和艾滋病毒预防的评论，最近也制定了临床指南，但还没有系统的研究来审查安全受孕的成本、潜在影响和成本效益，或对不同战略的实际偏好。我提出的指导研究计划将解决艾滋病毒预防研究中的这一关键差距。它包括两个阶段：第一阶段是一个小型的混合方法示范项目，在肯尼亚对更安全的受孕准则进行试点测试;第二阶段是一项研究，对准则的潜在影响和成本效益进行成本估算和建模。（1）开展一个混合方法示范项目，以（一）说明对不同的安全概念战略的遵守和偏好，以及（ii）估计在该设置中对组合安全概念计划的影响建模和设计大规模评估所需的参数。我将与肯尼亚研究团队一起，使用定量和定性方法来描述不同安全概念策略的吸收，坚持，患者和提供者偏好，并生成过程和影响结果的关键初步估计，以及结果的诊所间变异性。这项工作的结果将为目标2和3奠定基础;（2）估计肯尼亚尼扬扎省艾滋病毒不一致夫妇安全受孕的不同战略的成本，并建立影响和成本效益模型。我将在实施示范项目期间进行“微观成本计算”和时间与动作研究（见上文），以估计提供更安全的受孕方案所需的资源。我将使用的数据从示范项目和适当的历史队列模型的潜在影响和成本效益的不同策略的安全概念干预艾滋病毒的预防不和谐的夫妇在这种情况下;（3）制定一个初步计划，一个组合的安全概念干预，以防止艾滋病毒传播的艾滋病毒不和谐的夫妇在尼扬扎。在与当地利益相关者的参与式研讨会上，我们将批判性地评估研究结果，确定潜在的挑战，确定更安全的概念干预方案，并制定干预计划。在第四年，我将向NIH提交一份R系列申请，进行一项大规模研究，以确定干预措施的影响并估计其成本效益。