Mechanisms and pilot intervention for addressing intimate partner violence and HIV in antenatal care

解决产前护理中亲密伴侣暴力和艾滋病毒问题的机制和试点干预措施

• 批准号: 9978128
• 负责人: Abigail Mae Hatcher
• 金额: $ 16.34万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978128
• 关键词: Address; Adherence; Affect; Africa South of the Sahara; Attention; Behavioral; Career Mobility; Caring; Clinic; Country; Data; Development Plans; Dose; Drug usage; Elements; Enrollment; Ensure; Epidemiology; Experimental Designs; Feasibility Studies; Focus Groups; Foundations; Future; Goals; HIV; HIV Infections; HIV Seropositivity; Hair; Health; Health Services Accessibility; Health behavior; Improve Access; Income; Infant; Intervention; Interview; Lead; Learning; Life; Life Cycle Stages; Link; Longitudinal cohort; Malawi; Maps; Maternal Health; Maternal Mortality; Maternal and Child Health; Measures; Mental Depression; Mental Health; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; National Institute of Mental Health; North Carolina; Outcome; Participant; Pathway interactions; Perinatal; Personal Satisfaction; Pharmaceutical Preparations; Phase; Postpartum Period; Pregnancy; Pregnant Women; Prevention; Prospective cohort; Protocols documentation; Provider; Qualitative Research; Regimen; Reporting; Research; Research Design; Research Personnel; Risk Factors; Role; Safety; Sampling; Scientist; Site Visit; Solid; South Africa; South African; Supervision; Testing; Therapeutic; Time; Training; Translating; Universities; Vertical Disease Transmission; Viral; Viremia; Woman; Women' s Health; Work; Zambia; advanced analytics; antenatal; antenatal care; antiretroviral therapy; base; career; career development; cohort; depression prevention; depressive symptoms; design; evidence base; experience; follow-up; global health; implementation research; implementation science; inner city; intervention effect; intimate partner violence; maternal morbidity; medication compliance; modifiable risk; motherhood; multiphase optimization strategy; novel; perinatal intervention; perinatal women; peripartum depression; preference; programs; prospective; psychological distress; scaffold; secondary analysis; skills; social; standard of care; statistics; therapy adherence; treatment adherence; violence prevention

ABSTRACT This application to the National Institutes of Mental Health will provide Dr. Abigail Hatcher with five years K01 support for further training and mentored research. Dr. Hatcher is a social scientist at the University of North Carolina (UNC) with experience studying social drivers of HIV-related health. She has lived in South Africa since 2005, where she has established a solid career foundation for behavioral and social research around HIV and maternal health. The K01 award will provide essential training and professional scaffolding for a critical career transition, during which Dr. Hatcher will return to Chapel Hill after considerable time abroad to be an independent investigator and integral part of UNC Department of Health Behavior's global health research. Prevention of mother-to-child transmission (PMTCT) programs are only effective if women take medication regularly, yet many perinatal women in sub-Saharan Africa have sup-optimal adherence. Intimate partner violence (IPV) worsens women's ability to adhere to antiretroviral therapy (ART), and leads to higher rates of depression. Dr. Hatcher proposes 3 aims, each linked to a robust career development plan advancing analytical, adaptation, and implementation science skills. First, she will lead secondary analysis of longitudinal cohort data to determine mechanisms linking IPV to HIV-related health outcomes (ART adherence, viremia), exploring a hypothesized pathway of mental health. Coursework and mentorship in statistics and epidemiology (Drs. Levin, Turan, B, and Myer) will support her analyses. Second, qualitative research with perinatal women and health workers will explore identified pathways and intervention ideas. Dr. Hatcher will systematically adapt evidence-based mental health programs, enhanced by site visits to Malawi and Zambia, and mentorship from IPV and mental health experts (Drs. Maman, Christofides, and Pence). Third, she will conduct a feasibility study to assess acceptability of intervention content, measures, and study conditions. In a quasi- experimental design, she will assign 2 inner-city Johannesburg clinics to intervention or enhanced standard of care conditions. Following 80 women in a prospective cohort will allow for preliminarily assessment of intervention effects on key pathways (perinatal depression and IPV) and refinement of HIV measures (ART adherence using drug levels in hair samples). The feasibility study will be underpinned by coursework in implementation research study design and intensive supervised practice from experts in implementation science for PMTCT (Drs. Turan, J, Brahmbhatt, and Chi). Overall, the research will provide preliminary results to inform design of a future trial testing an optimized lay health worker strategy. By supporting didactic and field-based learning and protected time for research, a K01 will advance Dr. Hatcher's career progression as an independent HIV behavioral scientist, leading to better health and wellbeing among HIV-positive women.

抽象的 向美国国立心理健康研究所提交的这份申请将为阿比盖尔·哈切尔博士提供五年 K01 支持进一步的培训和指导研究。 Hatcher 博士是北方大学的社会科学家 卡罗莱纳州（北卡罗来纳大学）具有研究艾滋病毒相关健康的社会驱动因素的经验。她曾在南非生活过 自 2005 年以来，她为艾滋病毒行为和社会研究奠定了坚实的职业基础 和孕产妇健康。 K01 奖将为关键人员提供必要的培训和专业支架 职业转变期间，哈彻博士在国外呆了很长一段时间后将返回教堂山，成为一名 独立调查员和北卡罗来纳大学健康行为系全球健康研究的组成部分。 预防母婴传播 (PMTCT) 计划只有在女性服用药物的情况下才有效 但撒哈拉以南非洲的许多围产期妇女的依从性不佳。亲密伙伴 暴力（IPV）会恶化女性坚持抗逆转录病毒治疗（ART）的能力，并导致更高的患病率 沮丧。 Hatcher 博士提出了 3 个目标，每个目标都与稳健的职业发展计划相关 分析、适应和实施的科学技能。首先，她将领导纵向二次分析 队列数据以确定将 IPV 与 HIV 相关健康结果（ART 依从性、病毒血症）联系起来的机制， 探索心理健康的假设途径。统计学和流行病学课程和指导 （莱文博士、图兰博士、B 博士和迈尔博士）将支持她的分析。二、围产期妇女的定性研究 卫生工作者将探索已确定的途径和干预思路。海切尔博士将系统地 调整基于证据的心理健康计划，并通过对马拉维和赞比亚的实地访问以及指导来加强 由 IPV 和心理健康专家（Maman、Christofides 和 Pence 博士）提供。第三，她将举办一场 可行性研究，评估干预内容、措施和研究条件的可接受性。在准 根据实验设计，她将指派 2 个约翰内斯堡市中心诊所进行干预或提高标准 护理条件。通过追踪前瞻性队列中的 80 名女性，可以对以下情况进行初步评估： 对关键途径（围产期抑郁症和 IPV）的干预效果以及艾滋病毒措施的完善（ART 使用头发样本中的药物水平来确定依从性）。可行性研究将以课程作业为基础 实施研究设计和实施专家的强化监督实践 PMTCT 科学（Turan、J、Brahmbhatt 和 Chi 博士）。总体而言，研究将提供初步结果 为未来试验优化的非专业卫生工作者策略的设计提供信息。通过支持说教和 基于现场的学习和受保护的研究时间，K01 将推动 Hatcher 博士的职业发展 一位独立的艾滋病毒行为科学家，致力于改善艾滋病毒呈阳性女性的健康和福祉。