Preventing HIV in newborns and infants: the experience of Tanzanian mothers

说明(申请人提供)：目的：这项研究将探讨与坦桑尼亚农村地区预防艾滋病毒母婴传播的干预措施有关的问题。这项研究将研究社会和行为因素如何影响孕妇和新近分娩的母亲对艾滋病毒和母婴传播的检测、咨询和治疗。这项研究还将调查临床官员(如护士)和政策制定者(如地区、地区和国家卫生官员)如何看待他们在卫生设施一级提供预防母婴传播方面的作用，特别是他们在提供有效服务或制定有效政策以帮助母亲方面面临的障碍或促进因素。最终，这项研究旨在为从事母婴传播干预措施或政策的利益攸关方提供证据，说明如何以文化上可以接受的方式改进方案，并在此背景下具有可行性。 背景：尽管全球范围内预防母婴传播计划的覆盖率有所提高，但该计划仍有许多尚未解决的障碍。在撒哈拉以南非洲，预防母婴传播计划的累积损失从产前护理期间的28%，到分娩四个月后高达70%，到产后六个月接近81%。坦桑尼亚南部是受艾滋病毒/艾滋病疫情影响最严重的国家之一，但尚未发表任何研究报告，定性地调查获得防止母婴传播的障碍或便利因素。这项研究的作者试图通过定性地探讨这一问题，在她之前对坦桑尼亚孕妇和新近分娩的母亲进行爱抚的研究的基础上。这项研究的结果以及所有相关文书将与包括政策制定者和防止母婴传播的实施者在内的利益攸关方分享，目的不仅是分享研究结果，而且还分享可能被证明对类似情况下的数据收集有用的工具。方法：研究人群将以坦桑尼亚的莫罗戈罗为基地。将与至少10名提供防止母婴传播服务的卫生设施工作人员、至少10名参与防止母婴传播方案编制和执行的政策制定者以及至少30名18至35岁艾滋病毒阳性、在莫罗戈罗地区医院接受产前护理的孕妇或母亲进行深入访谈。这项研究将从本提案的主要导师收集的定量知识中提取，但将是定性的，并将受到社会认知理论和社会生态模型的启发。访谈母亲的抽样战略将涉及与医生、家庭护理提供者和研究人员的协调，以有目的地识别一组母婴传播患者。访谈诊所工作人员和政府官员的抽样战略也将是有目的的，重点是确定参与提供防止母婴传播服务的个人，即在诊所和政府办公室的生殖和儿童保健股工作的个人。

DESCRIPTION (provided by applicant): Aims: This study will explore issues related to uptake of and adherence to interventions addressing the prevention of mother-to-child transmission of HIV in rural Tanzania. The study will examine how social and behavioral factors affect testing, counseling and treatment for HIV and PMTCT among pregnant women and recently-delivered mothers. This study will also investigate how clinical officers (such as nurses) and policy makers (such as district, regional and national health officials) view their role in providing PMTCT at th health facility-level, specifically the barriers or facilitating factors they face to providing effctive services or devising effective policies to help mothers. Ultimately, this research aims to provide stakeholders who are engaging in PTMCT interventions or policies with evidence on how to improve programs in a manner that is culturally acceptable and feasible in this context. Background: Although there has been an increased coverage of PMTCT programs globally, there are still many unresolved barriers to the program. In sub-Saharan Africa, cumulative losses to follow up in PMTCT programs range from 28% during antenatal care, up to 70% four months after delivery and close to 81% by six months post-partum. In southern Tanzania, a country that is among the hardest hit by the HIV/AIDS epidemic, there have been no published studies qualitatively investigating barriers to or facilitating factors in accessing PMTCT. The author of this study seeks to build on her previous research on careseeking among pregnant women and recently-delivered mothers in Tanzania by qualitatively exploring this issue. Findings from this study as well as all related instruments will be shared with stakeholders including policy makers and PMTCT implementers, with the intention of not only sharing findings but also sharing tools that may prove useful for data collection in similar settings. Methods: The study population will be based in Morogoro, Tanzania. In-depth interviews will take place with at least 10 health facility staff who provide PMTCT services, at least 10 policy makers who engage in PMTCT programming and implementation and at least 30 pregnant women or mothers, who are HIV-positive, between 18 and 35 years of age, and attended ante-natal care at the Morogoro Regional Hospital. The study will draw from quantitative knowledge gathered by the primary mentor of this proposal, but will be qualitative in nature and informed by Social Cognitive Theory and the Social-Ecological Model. The sampling strategy for interviewing mothers will involve coordination with physicians, home-based care providers and research staff to purposively identify a group of PMTCT patients. The sampling strategy for interviewing clinic staff and governmental officials will also be purposive, with an emphasis on identifying individuals who engage in provision of PMTCT services, namely individuals working within the Reproductive and Child Health Units of clinics and government offices.