Facilitating HCV Treatment through Tailored Prenatal Care for HCV Infected, Substance using Pregnant Women

 描述(由申请人提供)：丙型肝炎病毒(丙型肝炎病毒)感染在越来越多的阿片类药物依赖(OD)孕妇中流行。非法药物使用，特别是怀孕期间阿片类药物的使用，在过去十年中急剧增加，从每1000名住院分娩中的1.19人增加到5.77人。由于静脉注射阿片类药物的使用率很高，40-75%的OD孕妇感染了丙型肝炎病毒，超过28%的孕妇在怀孕期间新诊断为丙型肝炎病毒。怀孕和产后期提供了独特的机会，利用孕妇识别、教育和接触感染了丙型肝炎病毒的物质。然而，许多感染了丙型肝炎病毒的孕妇没有得到适当的产前护理，只有不到2%的人在分娩后一年内开始接受丙型肝炎病毒治疗。在此R21应用程序中，我们建议定性评估三个关键利益相关群体(感染丙型肝炎病毒的妇产科患者、产前护理提供者和肝病专家)在向感染丙型肝炎病毒的妇产科妇女提供医疗服务方面的观点，以确定如何改进孕期丙型肝炎教育和评估，并促进产后丙型肝炎治疗。具体目的是：1)与感染丙型肝炎病毒的OD孕妇和产后患者进行个人半结构化访谈，了解患者对妊娠期间丙型肝炎病毒感染的看法，以及产后治疗的障碍和促进者；2)与产前护理提供者和肝病专家进行个体半结构化访谈，描述提供者对丙型肝炎病毒感染OD患者的最佳产前和产后护理服务的看法。定性方法和利益攸关方参与已成为研究过程的中心组成部分，以努力不仅提高干预措施的效力，而且提高其有效性。该R21项目的总体目标是了解导致丙型肝炎病毒携带者妇女产前护理不佳的因素，并确定改进孕期丙型肝炎病毒教育和评估的方法。这项提案的定性结果将(A)为促进产前和专科护理提供者之间的提供者间对话和护理协调的战略提供洞察力，(B)确定必要的内容和信息，以促使孕妇改善与丙型肝炎病毒相关的健康行为，并鼓励产后治疗，以及(C)为丙型肝炎病毒感染患者设计一种创新的产前护理干预措施，该干预措施将在随后的R01应用程序中进行测试，以确定分娩后一年的丙型肝炎治疗率。我们研究的广泛假设是，提高患者和提供者对丙型肝炎病毒的知识和认识将最大限度地提高怀孕期间对丙型肝炎病毒的识别和患者的参与度，并促进产后治疗感染丙型肝炎病毒的妇女，从而改善两代人的长期健康。

 DESCRIPTION (provided by applicant): Hepatitis C virus (HCV) infection is prevalent among a growing population of opioid dependent (OD) pregnant women. Illicit drug use and specifically, opioid use during pregnancy has increased dramatically over the last decade from 1.19 to 5.77 per 1,000 hospital births. Due to high rates of intravenous opioid use, 40-75% of OD pregnant women are infected with HCV and over 28% are newly diagnosed with HCV during pregnancy. Pregnancy and the postpartum period offer unique opportunities to identify, educate and engage HCV infected, substance using pregnant women. However, many HCV infected pregnant patients do not receive appropriate prenatal care and less than 2% initiate HCV treatment within one year following delivery. In this R21 application, we propose to qualitatively evaluate the perspectives of 3 key stakeholder groups (HCV infected OD patients, prenatal care providers and hepatologists) involved in the delivery of health care services to HCV infected OD pregnant and postpartum women to identify ways to improve HCV education and evaluation during pregnancy and facilitate HCV treatment after delivery. The specific aims are: 1) Conduct individual semi- structured interviews with HCV infected OD pregnant and postpartum patients to understand the perspectives of patients regarding HCV infection during pregnancy and barriers and facilitators to postpartum treatment; 2) Conduct individual semi-structured interviews with prenatal care providers and hepatologists to describe the perspectives of providers regarding optimal prenatal and postpartum care delivery for HCV infected OD patients. Qualitative approaches and stakeholder engagement have become a central component of the research process in an effort to improve not only the efficacy, but the effectiveness of interventions. The overall goal of this R21 project is to understand the factors that contribute to suboptimal prenatal care for women with HCV and identify ways to improve HCV education and evaluation during pregnancy. The qualitative findings from this proposal will (a) offer insight into strategies to foster inter-provider dialogue and care coordination among prenatal and specialist care providers, (b) identify content and messaging necessary to engage pregnant patients in improved HCV-related health behavior and encourage postpartum treatment, and (c) inform the design an innovative prenatal care intervention for patients with HCV infection which will be tested in a subsequent R01 application on rates of HCV treatment one year after delivery. The broad hypothesis of our study is that improving patient and provider HCV knowledge and awareness will maximize HCV identification and patient engagement during pregnancy and facilitate postpartum treatment for HCV infected, substance using women thereby improving the long-term health of two generations.