Perinatal depression and key care outcomes in pregnant Malawian women with HIV

项目概要/摘要 对艾滋病毒感染者的抗逆转录病毒治疗可有效减少新的艾滋病毒感染。在亚- 在撒哈拉非洲，育龄妇女是ART的重要对象，以提高她们自身的 健康以及预防艾滋病毒传染给其性伴侣和婴儿。在马拉维， 在南部非洲，成年妇女的艾滋病毒感染率高达13%。马拉维是第一个撒哈拉以南非洲国家 非洲将采用“备选方案B+”，这是世界卫生组织的一项倡议， 无论CD 4计数如何，终身接受抗逆转录病毒治疗的孕妇，这是抗逆转录病毒治疗资格标准的重大扩展。 备选办法B+有可能大幅度减少艾滋病毒的传播以及妇女的发病率和死亡率，但 只有当妇女能够长期接受抗逆转录病毒治疗，并保持病毒抑制所需的高度依从性时。 选项B+方案使马拉维开始抗逆转录病毒疗法的妇女人数急剧增加，但 在使妇女继续接受艾滋病毒护理、治疗和产后病毒抑制方面所做的努力不足。 HIV护理的保留，ART依从性和病毒抑制受到潜在可改变的 心理社会因素，包括围产期抑郁症。抑郁症在艾滋病毒感染者中更为常见 比一般人多。虽然抑郁症已被证明会对艾滋病毒的结果产生负面影响， 在美国，没有研究检查围产期抑郁症对保持护理和病毒感染的影响。 在非洲感染艾滋病毒的孕妇中进行压制。 本Kirschstein-NRSA个人研究金（F30）提案的总体目标是确定 围产期抑郁症对两个关键HIV护理结果影响--继续护理和病毒抑制 - 在马拉维感染艾滋病毒的孕妇中。结果将确定的负担和时间 不断增长的选项B+人群中的围产期抑郁症，并为未来有关精神疾病的政策决定提供信息。 在马拉维和可能的其他备选方案B+撒哈拉以南非洲国家为感染艾滋病毒的妇女提供保健。 该建议的具体目标是：1）估计围产期抑郁症的患病率和发病率; 2)确定产后抑郁症的预测因素; 3）估计围产期抑郁症与产后抑郁症的相关性。 抑郁症与保持在照顾和病毒抑制。拟议的研究是嵌套在一个 正在进行的纵向队列研究，旨在检查Option B+的长期安全性和疗效 马拉维的计划。 通过这个研究项目和精心制定的培训计划，学员将实现以下目标 奖学金目标：1）发展基于人群的研究设计，数据收集，分析和 结果的交流; 2）获得临床和转化研究的技能，以促进临床研究的整合 和研究追求;和3）发展专业技能，这将有助于成功的学术生涯。

Project summary/Abstract Antiretroviral treatment (ART) for HIV-infected persons is effective at reducing new HIV infections. In sub- Saharan Africa, women of reproductive age are an important target for ART in order to improve their own health as well as to prevent HIV transmission to their sexual partners and their infants. In Malawi, a country in southern Africa, HIV prevalence in adult women is high at 13%. Malawi was the first country in sub-Saharan Africa to adopt “Option B+,” a World Health Organization initiative to start and maintain all HIV-infected pregnant women on lifelong ART regardless of CD4 count, a significant expansion in ART eligibility criteria. Option B+ has the potential to substantially reduce HIV transmission and women's morbidity and mortality, but only if women can be retained on ART long-term with the high adherence required to sustain viral suppression. The Option B+ program has led to a dramatic increase in the number of women starting ART in Malawi, but efforts at keeping women in HIV care, on treatment, and virally suppressed post-delivery have fallen short. Retention in HIV care, ART adherence, and viral suppression are influenced by potentially modifiable psychosocial factors, including perinatal depression. Depression is more common among HIV-infected persons than among the general population. While depression has been shown to negatively impact HIV outcomes in the United States, no studies have examined the impact of perinatal depression on retention in care and viral suppression among HIV-infected pregnant women in Africa. The overall objective of this Kirschstein-NRSA individual fellowship (F30) proposal is to identify the influence perinatal depression on two key HIV care outcomes – retention in care and viral suppression – among HIV-infected pregnant women in Malawi. The results will establish the burden and timing of perinatal depression in the growing Option B+ population and inform future policy decisions regarding mental health care for HIV-infected women in Malawi and possibly other Option B+ sub-Saharan African countries. The specific aims of this proposal are: 1) Estimate the prevalence and incidence of perinatal depression; 2) Identify predictors of incident postpartum depression; and 3) Estimate the association of perinatal depression with retention in care and viral suppression. The proposed research is nested within an ongoing longitudinal cohort study designed to examine the long-term safety and efficacy of the Option B+ program in Malawi. Through this research project and a carefully constructed training plan, the trainee will achieve the following fellowship goals: 1) develop advanced skills in population-based study design, data collection, analysis, and communication of results; 2) acquire skills in clinical and translational research to facilitate integration of clinical and research pursuits; and 3) develop professional skills that will facilitate a successful academic career.