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Integrating HIV with Innovative Group Antenatal Care in Two African Countries

在两个非洲国家将艾滋病毒与创新的团体产前护理相结合

基本信息

批准号：
8736012
负责人：
Crystal Lauren Patil
金额：
$ 12.88万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-18 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8736012
关键词：
AIDS prevention Accounting Address Adherence Adult Africa Africa South of the Sahara African Attention Awareness Behavioral Birth Caring Client Clinic Clinical Trials Cognitive Community Health Continuity of Patient Care Counseling Country Couples Data Development Early treatment Education Evaluation Exercise Future Goals HIV HIV Infections HIV Seropositivity Health Health Priorities Health care facility Health education Health system Healthcare Heterosexuals High Prevalence Hour Human immunodeficiency virus test Individual Infant Infection Information Services Institutes Intervention Interview Knowledge Learning Link Malawi Mediation Modeling Outcome Outcome Measure Policy Maker Pre-Post Tests Pregnancy Pregnant Women Premature Birth Prevalence Prevention Prevention education Primary Prevention Procedures Process Provider Quality of Care Randomized Reporting Research Research Personnel Resources Rural Schedule Self Efficacy Services Site Tanzania Testing Time Training Vertical Disease Transmission Visit Woman Work base behavior change community based participatory research condoms efficacy testing evidence base follow-up forging global health health knowledge improved innovation meetings men public health relevance randomized trial safer sex satisfaction skills success transmission process

项目摘要

DESCRIPTION (provided by applicant): Reducing new HIV infections is a global health priority, especially in sub-Saharan Africa, where 70% of new HIV infections and 75% of vertical infections occur. Due to shortages in health workers and other resources, significant coverage gaps exist in initial HIV testing of pregnant women at antenatal care (ANC) and referrals of those who are HIV-positive for prevention of mother-to-child transmission (PMTCT) and treatment. Furthermore, almost no attention is given to the prevention needs of HIV-negative pregnant women at ANC. As a result, researchers and policy makers have called for innovative approaches to reconceptualize the ANC- HIV-PMTCT care continuums. The proposed R21 will be the first adaptation of the CenteringPregnancy (CP) group ANC care model in low-resource, high HIV prevalence settings. The shift to group care is an innovative paradigm that makes more efficient use of scare health practitioner time and improves quality of care by incorporating essential HIV-related information and services into ANC for all women, regardless of HIV status. In CP-Africa, a group of 12 mixed status (HIV positive and negative) women with similar due dates meet with the same trained practitioner at every ANC visit. Self and practitioner assessments and practitioner-initiated linkages to others services (e.g., PMTCT) occur in the first 30 minutes. This is followed by 90 minutes of education and skill-building to promote awareness of HIV testing, prevention, and treatment options and build self-efficacy leading to behavioral changes and increased health system use. Continuity of care will strengthen linkages to HIV-related and other services as women forge a collaborative relationship with a specific practitioner. Couples testing is promoted by inviting men to an HIV session followed by a testing opportunity. This R21 will be used to complete essential developmental work that will enable us to bring this paradigm- changing model to sub-Saharan Africa and allow us to move toward testing the efficacy of CP-Africa on a large scale. Guided by principles of community-based participatory research, we will develop and pilot CP-Africa in Malawi and Tanzania, countries with different HIV prevalence (11% vs. 6%), HIV testing rates, and PMTCT coverage. ANC sessions and activities, procedures to schedule practitioner time, meeting space, form groups and facilitate follow-up on individual women's HIV, PMTCT, and other needed services will be developed collaboratively with stakeholders. Outcome measures new to sub-Saharan Africa will be validated by cognitive interviewing. We will then pilot the entire CP-Africa package at 4 sites with 192 women randomized into CP- Africa or individualized care; obtain baseline, late pregnancy and 8 week post birth outcome data; and conduct full process evaluations of the implementation process including direct observation of sessions and qualitative assessments by women and providers. Data from this study will be collated and used to refine the CP-Africa package to prepare for a clinical trial. If CP-Africa can be successfully adapted in two African countries, this will enhance the likelihood of success in other low-resource settings.

减少新的艾滋病毒感染是全球卫生的优先事项，特别是在撒哈拉以南非洲，那里发生了70%的新的艾滋病毒感染和75%的垂直感染。由于卫生工作者和其他资源短缺，在产前护理中对孕妇进行初步艾滋病毒检测以及将艾滋病毒抗体阳性者转诊进行预防母婴传播和治疗方面存在重大覆盖差距。因此，研究人员和决策者呼吁采取创新办法，重新构想ANC-艾滋病毒-防止母婴传播护理的连续性。拟议的R21将是在资源匮乏、艾滋病毒流行率高的环境中首次采用CenteringPregnancy（CP）小组ANC护理模式。向集体护理的转变是一种创新模式，它更有效地利用了保健医生的宝贵时间，并通过将与艾滋病毒有关的基本信息和服务纳入面向所有妇女的产前护理，而不论其艾滋病毒状况如何，来提高护理质量。在非洲预防艾滋病方案，一组12名预产期相似的混合身份（艾滋病毒阳性和阴性）妇女在每次产前护理访问时与同一名训练有素的从业人员会面。自我和从业者评估以及从业者发起的与其他服务的联系（例如，PMTCT）发生在前30分钟。接下来是90分钟的教育和技能建设，以提高对艾滋病毒检测，预防和治疗方案的认识，并建立自我效能，从而改变行为并增加卫生系统的使用。护理的连续性将加强与艾滋病毒相关服务和其他服务的联系，因为妇女与特定的从业人员建立了合作关系。通过邀请男子参加艾滋病毒课程，随后提供检测机会，促进夫妇检测。这一R21将用于完成重要的发展工作，使我们能够将这一改变范式的模式带到撒哈拉以南非洲，并使我们能够大规模测试CP-Africa的功效。在基于社区的参与性研究原则的指导下，我们将在马拉维和坦桑尼亚开发和试点CP-非洲，这两个国家具有不同的艾滋病毒流行率（11%对6%），艾滋病毒检测率和预防母婴传播覆盖率。将与利益攸关方合作，制定产前护理会议和活动、安排从业人员时间、会议空间、组建小组和促进对个别妇女艾滋病毒、防止母婴传播和其他所需服务的后续行动的程序。新的撒哈拉以南非洲的成果措施将通过认知访谈进行验证。然后，我们将在4个研究中心对192名随机分配到CP-Africa或个体化护理的妇女进行整个CP-Africa包的试点;获得基线、妊娠晚期和出生后8周的结果数据;并对实施过程进行全过程评估，包括妇女和提供者对会议的直接观察和定性评估。本研究的数据将被整理并用于完善CP-Africa包，为临床试验做准备。如果非洲国家方案能够在两个非洲国家成功地加以调整，这将提高在其他资源匮乏环境中取得成功的可能性。