Healthy Options: Group psychotherapy for HIV-positive depressed perinatal women

健康选择：针对艾滋病毒阳性抑郁围产期妇女的团体心理治疗

• 批准号: 9061023
• 负责人: Sylvia Kaaya
• 金额: $ 39.67万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9061023
• 关键词: Acquired Immunodeficiency Syndrome; Address; African; Area; Caring; Child; Chronic; Chronic Disease; Clinic; Clinical; Cognitive Therapy; Communities; Counseling; Depressed mood; Depression screen; Disease; Disincentive; Goals; Government; Group Psychotherapy; Guidelines; HIV; HIV Seropositivity; Health; Health Personnel; Health Policy; Health Professional; Health Services Accessibility; Health Status; Healthcare; Individual; Intervention; Knowledge; Life; Link; Major Depressive Disorder; Maternal and Child Health; Mental Depression; Mental Health; Mental Health Services; Morbidity - disease rate; Neurologist; Nurse Midwives; Nurse Psychotherapist; Nurses; Patient Care; Patients; Perinatal; Persons; Physicians; Policies; Population; Postpartum Period; Pregnancy; Pregnant Women; Prevalence; Prevention; Primary Health Care; Problem Solving; Provider; Psyche structure; Psychiatric Nursing; Psychiatrist; Psychologist; Randomized Controlled Trials; Reporting; Research; Resources; Risk; Running; Self Efficacy; Services; Social Functioning; Social Workers; Suicide; Symptoms; Tanzania; Time; Vulnerable Populations; Woman; Work; antiretroviral therapy; base; coping; depressive symptoms; evidence base; experience; group counseling; group intervention; health care service; improved; innovation; low and middle-income countries; pregnant; prevent; prevention service; screening; skills; standard of care; therapy adherence; tool; transmission process; trial comparing

DESCRIPTION (provided by applicant): In resource-limited settings, there has been a significant increase in access to antiretroviral therapy (ART) in recent years. In 2010, 6.6 millio people had access to ART in low- and middle-income countries, increasing by 16-fold compared to access in 2003. Although there remain serious limitations in access to ART in these settings, for many who have initiated and continue treatment, HIV disease is a chronic condition that needs to be managed over time. There is considerable evidence that individuals with chronic illness have an increased risk of depression, in part related to the challenges in coping and managing their illness. Among persons living with HIV and AIDS (PLHA) in Tanzania, the prevalence of symptoms comparable to major depressive disorder (moderate to severe depression) was reported as 10.5%, with over 45% presenting with milder forms of depression in an urban setting. Rates for depression during pregnancy in women living with HIV are estimated to be higher, with more than 40% experiencing symptoms comparable to major depressive disorder (MDD). Despite this relatively high burden of depression among PLHA, it has been documented that clinical staff working with PLHA do not routinely identify or treat depression in this setting. This is in contrast to recent revisions in the Tanzanian health policy that emphasize integrating mental health and HIV care at district and lower level health care services. The long-term intent of the research is to bridge this gap between Tanzanian health policy and implementation of integrating mental health care among pre- and post-natal women receiving HIV care. Therefore, the overall goal of the proposed study is to examine the potential for successful integration of enhanced mental health care and group counseling among HIV- positive women receiving PMTCT-plus services and to evaluate a combination of evidence-based approaches in treatment of depression in this vulnerable population in Tanzania. Specifically this application aims to: 1) Examine the acceptability and feasibility of integrating n enhanced standard of mental health care and group counseling with PMTCT-plus services provided at government-run maternal and child health (MCH) clinics, from the perspectives of: a) facility mental health care focal points and MCH clinic managers, b) perinatal direct care providers; and c) HIV-positive perinatal women; 2) Validate a depression screening tool for major depressive disorder (MDD) and suicidality for use in Tanzania; and 3) Conduct a cluster randomized controlled trial comparing a task-sharing approach (i.e. problem solving and cognitive behavioral therapy components delivered to groups facilitated by lay community based health care workers; CBHWs) versus improved standard of care for the treatment of depression among HIV-positive women accessing PMTCT-plus services.

描述（由申请人提供）：在资源有限的环境中，近年来获得抗逆转录病毒治疗（ART）的机会显着增加。2010年，中低收入国家有660万人获得抗逆转录病毒治疗，比2003年增加了16倍。虽然在这些环境中获得抗逆转录病毒治疗仍然存在严重的限制，但对于许多已经开始并继续接受治疗的人来说，艾滋病毒疾病是一种慢性疾病，需要随着时间的推移进行管理。有相当多的证据表明，患有慢性疾病的人患抑郁症的风险增加，部分原因与应对和管理疾病的挑战有关。在坦桑尼亚的艾滋病毒和艾滋病感染者中，据报告，与重度抑郁症（中度至重度抑郁症）相当的症状的患病率为10.5%，在城市环境中，超过45%的人表现为轻度抑郁症。据估计，感染艾滋病毒的妇女在怀孕期间患抑郁症的比率更高，超过40%的妇女经历了与重度抑郁症（MDD）相当的症状。尽管PLHA的抑郁负担相对较高，但有记录表明，与PLHA一起工作的临床工作人员在这种情况下不会常规识别或治疗抑郁症。这与坦桑尼亚最近修订的卫生政策形成鲜明对比，后者强调将精神健康和艾滋病毒护理纳入地区和较低一级的卫生保健服务。这项研究的长期目的是弥合坦桑尼亚卫生政策与在接受艾滋病毒护理的产前和产后妇女中实施综合精神保健之间的差距。因此，拟议的研究的总体目标是检查在接受预防母婴传播加服务的艾滋病毒阳性妇女中成功整合增强的心理健康护理和团体咨询的潜力，并评估在坦桑尼亚这一弱势群体中治疗抑郁症的循证方法组合。 具体而言，本申请的目的是：1）从以下角度审查将提高的心理保健标准和团体咨询与政府开办的妇幼保健诊所提供的预防母婴传播附加服务相结合的可接受性和可行性：a）设施心理保健协调中心和妇幼保健诊所管理人员，B）围产期直接保健提供者;以及c）艾滋病毒阳性的围产期妇女; 2）在坦桑尼亚使用一种抑郁症筛查工具，用于重度抑郁症（MDD）和自杀倾向; 3）进行一项集群随机对照试验，比较任务分担方法（即由非专业社区卫生保健工作者协助向群体提供解决问题和认知行为治疗的组成部分; CBHWs）与改善获得PMTCT+服务的艾滋病毒阳性妇女治疗抑郁症的护理标准。