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

摘要 向美国国立精神卫生研究院提出的申请将为阿比盖尔·哈彻博士提供五年的K 01 支持进一步的培训和指导研究。哈彻博士是北方大学的社会科学家 卡罗莱纳（Carolina），具有研究艾滋病毒相关健康的社会驱动因素的经验。她住在南非 自2005年以来，她为围绕艾滋病毒的行为和社会研究奠定了坚实的职业基础 和产妇保健。K 01奖将提供必要的培训和专业脚手架的关键 在此期间，哈彻博士将在国外呆上相当长的一段时间后回到查佩尔山， 独立调查员和卫生行为部全球健康研究的组成部分。 预防母婴传播（PMTCT）方案只有在妇女服用药物的情况下才有效 然而，撒哈拉以南非洲的许多围产期妇女有超最佳的依从性。亲密伴侣 暴力（IPV）降低了妇女坚持抗逆转录病毒治疗（ART）的能力，并导致更高的 萧条Hatcher博士提出了3个目标，每个目标都与一个强大的职业发展计划相关联， 分析，适应和实施科学技能。首先，她将领导纵向的二次分析， 队列数据，以确定IPV与HIV相关健康结局（ART依从性、病毒血症）之间的联系机制， 探索一条假想的心理健康之路统计学和流行病学的课程作业和辅导 (Drs. Levin、Turan、B和Myer）将支持她的分析。第二，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想法。哈彻博士会系统地 调整以证据为基础的心理健康计划，通过对马拉维和赞比亚的实地访问和指导来加强 来自IPV和心理健康专家（Maman，Christofides和Pence博士）。第三，她将进行一次 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- 实验设计，她将分配2个市中心约翰内斯堡诊所进行干预或提高标准， 护理条件。在前瞻性队列中随访80名女性将允许对以下情况进行初步评估： 对关键途径（围产期抑郁症和IPV）的干预效果和艾滋病毒措施（ART）的改进 使用毛发样品中的药物水平的依从性）。可行性研究将得到以下课程的支持： 执行研究、研究设计和执行专家的密集监督实践 预防母婴传播的科学（Turan，J，Brahmbhatt和Chi博士）。总的来说，这项研究将提供初步结果， 为未来的试验设计提供信息，以测试优化的非专业卫生工作者策略。通过支持说教和 基于现场的学习和保护时间的研究，K 01将推进博士。 一个独立的艾滋病毒行为科学家，导致艾滋病毒阳性妇女更好的健康和福祉。

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.