Mother Infant Retention Across the Option B plus Cascade

选项 B 加级联的母婴保留率

• 批准号: 8989730
• 负责人: William John Reidy
• 金额: $ 18.82万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8989730
• 关键词: Achievement; Address; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Awareness; Breast Feeding; CD4 Lymphocyte Count; Caring; Cessation of life; Client satisfaction; Clinic; Clinic Visits; Country; Data; Disclosure; Early Diagnosis; Enrollment; Ensure; Face; Frequencies; Generations; Gestational Age; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health care facility; High Prevalence; Human immunodeficiency virus test; Infant; Infant Care; Intervention; Interview; Knowledge; Left; Malawi; Measures; Morbidity - disease rate; Mothers; Outcome; Patient Transfer; Patients; Performance; Populations at Risk; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Prevention program; Provider; Psychosocial Influences; Reporting; Research; Risk; Site; Staging; Surveys; Swaziland; Telephone; Update; Vertical Disease Transmission; Visit; Vital Status; Woman; antiretroviral therapy; base; care delivery; evidence base; follow-up; high risk; improved; mortality; patient population; postnatal; pregnant; programs; public health relevance; scale up; social stigma; success; therapy development; transmission process

 DESCRIPTION (provided by applicant): The current scale-up of Option B+ programs for the prevention of mother-to-child transmission (PMTCT) of HIV promises to escalate achievement of two important goals through initiation of antiretroviral therapy (ART) in all pregnant and breastfeeding women: reduced morbidity and mortality for HIV-infected women and decreased HIV transmission from mother to infant. Crucial to the success of the Option B+ strategy is retention in care throughout the PMTCT cascade: from early diagnosis of HIV infection in pregnant women, their engagement in antenatal care, to ART initiation, follow-up antenatal visits, facility-based delivery by skilled providers, and post- delivery care for both the mother ad infant, including determining final HIV infection status for the infant following cessation of breastfeeding. Option B+ was implemented at 10 health facilities in Swaziland on a pilot basis as part of the Situkulwane Lesiphephile-Safe Generations (Safe Generations) study. Preliminary data from this study suggest that at least 50% of the women who initiated PMTCT care under Option B+ at these sites were lost to follow up (LTF). Other studies have also shown high rates of LTF for pregnant women enrolled in ART and PMTCT care, including Option B+. Previous research has shown that substantial proportions of adult HIV patients reported as LTF were either in care at another clinic (i.e., self-transfers) or have died without program awareness of their death. However, little is known regarding outcomes of the women enrolled in Option B+ programs. Thus, we propose to assess the outcomes of women recorded as LTF in Safe Generations study, and their infants, to determine the proportion alive and engaged in care, alive and disengaged from care, and those who have died, as well as infant vital and HIV status. The proposed 2- year study will involve the conduct of telephone and physical tracing of the estimated 500-600 women LTF using contact information provided by patients at initiation of HIV care to assess patient vital status and retention in ART care, reasons for loss from care, along with their infant's vital and HIV status, if latter is available. Information collected from these interviews will be integrated with Safe Generations study data to provide updated patient outcomes and patient reasons for LTF and disengagement. This updated study data will be analyzed to describe levels of engagement at key points throughout the care cascade, identify determinants for LTF and disengagement, and understand common self-identified reasons for disengagement from care throughout the PMTCT cascade. Study findings will provide crucial new evidence to guide interventions to improve Option B+ performance and, consequently, reduce HIV-related mortality among women and bring us closer to the goal of elimination of mother-to-child transmission of HIV.

 描述(由申请人提供)：目前扩大方案B+预防艾滋病毒母婴传播(PMTCT)方案承诺通过在所有孕妇和哺乳妇女中启动抗逆转录病毒疗法(ART)来逐步实现两个重要目标：减少艾滋病毒感染妇女的发病率和死亡率，以及减少艾滋病毒从母亲到婴儿的传播。备选方案B+战略成功的关键是在整个预防母婴传播级联中保持护理：从孕妇艾滋病毒感染的早期诊断、她们参与产前护理，到启动抗逆转录病毒治疗、产前随访、由熟练的提供者在设施中分娩以及对母亲和婴儿的产后护理，包括在停止母乳喂养后确定婴儿最终的艾滋病毒感染状态。作为Situkulwane Lesiphephile--安全世代(安全世代)研究的一部分，在斯威士兰的10个保健机构试行了备选方案B+。这项研究的初步数据表明，在这些地点根据选项B+启动预防母婴传播护理的妇女中，至少有50%失去了随访(LTF)。其他研究也表明，参加抗逆转录病毒治疗和母婴传播治疗的孕妇的长期转移率很高，包括选项B+。先前的研究表明，报告为LTF的成年HIV患者中，有相当大一部分要么在另一家诊所接受治疗(即自我转移)，要么在没有程序意识到自己死亡的情况下死亡。然而，人们对参加选项B+项目的女性的结果知之甚少。因此，我们建议评估在《安全生育研究》中记录为LTF的妇女及其婴儿的结局，以确定活着和参与护理、活着和脱离护理的比例，以及那些已经死亡的人，以及婴儿的生命和艾滋病毒状况。拟议的为期两年的研究将涉及使用患者在艾滋病毒护理开始时提供的联系信息对大约500-600名长期转移妇女进行电话和实物追踪，以评估患者的生命状况和在抗逆转录病毒治疗中的保留情况、失去护理的原因以及婴儿的生命和艾滋病毒状况(如果有的话)。从这些访谈中收集的信息将与安全世代研究数据相结合，以提供最新的患者结局和患者对LTF和脱离接触的原因。这项更新的研究数据将被分析，以描述整个护理级联中关键点的参与程度，确定长期转移和脱离的决定因素，并了解整个预防母婴传播级联中脱离护理的常见自我确定的原因。研究结果将提供重要的新证据，以指导采取干预措施，提高备选方案B+的绩效，从而降低妇女中与艾滋病毒有关的死亡率，使我们更接近消除艾滋病毒母婴传播的目标。