Adherence to HIV Treatment Postpartum: The Implications of Transitions Among Women Living with HIV in South Africa

项目摘要 预防母婴传播的努力降低了母婴垂直传播的比率， 然而，最佳抗逆转录病毒治疗（ART）依从性仍然是一个困难的目标， 尤其是产后。预计拟议研究的贡献是双重的：1）获得 了解在此期间有影响力的情境、人际、临床和个人层面因素如何变化 关键时刻的过渡期间怀孕和产后，并影响ART坚持和2）发展 生物行为干预措施，以帮助母亲在产后坚持抗逆转录病毒疗法。候选人：我 我是一名社会心理学家，在美国的社会弱势群体中具有ART坚持的背景 States.我正在申请一个为期五年的K 01职业发展奖，以获得培训，指导， 在资源有限的情况下成为感染艾滋病毒的妇女产妇保健专家的研究经验 设置和独立调查员能够获得R 01资金。导师：我已经把一个 在南方艾滋病毒治疗和预防研究方面具有丰富经验的杰出辅导团队 非洲，整合流行病学，定性方法和临床科学。Don Operario博士和Mark博士 Lurie将担任联合主要导师，并在国际艾滋病毒行为方面提供补充专业知识。 干预发展和传染病流行病学。除了我的两个主要导师，我的合作伙伴， 导师提供特定内容领域和方法方面的专业知识， 南非（ZA）。我的共同导师团队包括：Susan Cu-Uvin博士（美国）基于临床的管理 艾滋病毒，产科和妇科），Landon Myer博士（基于ZA，围产期流行病学，产后ART Abigail Harrison博士（美国-基于纵向定性方法，性和生殖 Christopher Colvin博士（基于ZA的定性方法，妇幼保健）。培训：具体 围产期流行病学培训，纵向定性方法，基于理论的干预措施，跨文化 将通过强化辅导培训、课程作业 研讨会和指导阅读和初级ZA研究。在我优秀的导师团队的指导下，这些 培训和研究经验将建立我的独立调查员的职业生涯，作为一个专家，在发展 采取艾滋病毒治疗和预防干预措施，在影响大、资源少的情况下解决孕产妇保健问题， 考虑到影响健康行为的过渡和变化的关键时刻。研究：The 拟议项目的目标是：（1）确定环境、人际、临床和个人层面的因素， 影响妇女在怀孕和产后关键过渡期坚持艾滋病毒治疗; (2)评估基于过渡理论的生物行为干预，以改善产后ART依从性 使用小规模随机对照试验;（3）评估参与者的干预经验， 认识到的有用性，并确定改进干预措施的方法，以供今后评估

PROJECT SUMMARY Prevention of mother-to-child transmission (PMTCT) efforts have reduced the rates of vertical transmission to 2.7%, however, optimal antiretroviral therapy (ART) adherence remains a difficult goal to reach, particularly postpartum. The contribution of the proposed research is expected to be two-fold: 1) to gain an understanding of how influential contextual, interpersonal, clinic, and individual level factors change during key moments of transition during pregnancy and postpartum and influence ART adherence and 2) to develop bio-behavioral interventions to assist mothers in maintaining their adherence to ART postpartum. Candidate: I am a social psychologist with a background in ART adherence socially disadvantaged groups in the United States. I am applying for a five-year K01 Career Development Award to obtain training, mentorship, and research experience to become an expert in maternal health among women living with HIV in resource limited settings and an independent investigator capable of obtaining R01 funding. Mentoring: I have put together an exceptional mentoring team with extensive experience in HIV treatment and prevention research in South Africa that integrates epidemiology, qualitative methods, and clinical science. Drs. Don Operario and Mark Lurie will serve as co-Primary mentors and bring complementary expertise in international HIV behavioral intervention development and infectious disease epidemiology. In addition to my two Primary mentors, my co- mentors provide expertise in specific content areas and methodologies and are based in both the U.S. and South Africa (ZA). My co-mentorship team includes: Dr. Susan Cu-Uvin (U.S.-based, clinical management of HIV, obstetrics and gynecology), Dr. Landon Myer (ZA-based, perinatal epidemiology, postpartum ART adherence), Dr. Abigail Harrison (U.S.-based, longitudinal qualitative methods, sexual and reproductive health), and Dr. Christopher Colvin (ZA-based, qualitative methods, maternal child health). Training: Specific training in perinatal epidemiology, longitudinal qualitative methods, theory-based interventions, cross-cultural intervention development and evaluation will be achieved through intensive mentored training, coursework, workshops and directed readings and primary ZA research. Guided by my excellent mentorship team, these training and research experiences will establish my independent investigator career as an expert in developing HIV treatment and prevention interventions to address maternal health in high impact, low resource settings, that take into account key moments of transition and change that impact health behaviors. Research: The goals of the proposed project are to (1) identify contextual, interpersonal, clinic, and individual level factors that influence women's HIV treatment adherence during key period of transition during pregnancy and postpartum; (2) evaluate a Transition Theory-based bio-behavioral intervention to improve ART adherence postpartum using a small scale randomized controlled trial; (3) assess participants' experiences of the intervention, perceived usefulness, and identify ways to refine the intervention for future evaluation