Promoting PrEP shared decision-making and adherence among pregnant and breastfeeding women in Zambia

促进赞比亚孕妇和哺乳期妇女共同决策和遵守 PrEP

• 批准号: 10300058
• 负责人: Lauren Hill
• 金额: $ 18.12万
• 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: 2019-12-17 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10300058
• 关键词: AIDS prevention; Acute; Address; Adherence; Africa South of the Sahara; Award; Behavior Therapy; Behavioral Research; Breast Feeding; Clinical; Cognitive; Complement; Conflict (Psychology); Counseling; Country; Data; Decision Making; Development; Disincentive; Doctor of Philosophy; Effectiveness; Ensure; Evaluation; Foundations; Future; Goals; Guidelines; HIV; HIV Infections; HIV risk; Health Personnel; Horizontal Disease Transmission; Individual; Infection; Intervention; Knowledge; Life Style; Medical; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Modification; Mother-to-child HIV transmission; Motivation; Needs Assessment; Nurses; Oral; Participant; Patients; Perception; Pharmaceutical Preparations; Pilot Projects; Plasma; Postpartum Period; Pregnancy; Pregnant Women; Prevention; Primary Prevention; Process; Protective Agents; Provider; Randomized; Research; Research Personnel; Risk; Role; Scientist; Self Efficacy; Services; Tenofovir; Testing; Time; Training; Training Programs; Vagina; Vertical Disease Transmission; Woman; Zambia; acceptability and feasibility; antenatal; antenatal care; career; career development; design; effectiveness trial; emtricitabine; experience; improved; male; medication compliance; novel; patient oriented; person centered; pill; pilot test; pilot trial; pre-exposure prophylaxis; preference; pregnant; prevent; sex; shared decision making; skills; standard of care; therapy design; tool; training opportunity; treatment effect

ABSTRACT Pre-exposure prophylaxis (PrEP) is a promising tool for the prevention of HIV acquisition during pregnancy and the postpartum period and is a recommended component of a comprehensive package of prevention of mother- to-child HIV transmission services. Yet, few strategies exist to promote person-centered shared decision-making about PrEP use during pregnancy and breastfeeding despite the complexity of this decision and the importance of shared decision-making for medication adherence. The proposed training and research plan in this Mentored Research Scientist Development Award (K01) application will provide the essential training and skills that the principle investigator, Dr. Lauren M. Hill, PhD, needs to launch a productive career in PrEP decision-making research and in the development and evaluation of behavioral interventions to promote the utilization of and adherence to medicines for the prevention and treatment of HIV. Further, the research conducted throughout the course of this award would contribute meaningfully to the successful delivery of PrEP in the context of antenatal care in sub-Saharan Africa to ensure that decision-making regarding PrEP use by pregnant and breastfeeding women is person-centered to encourage appropriate and adherent use. To achieve this, Dr. Hill proposes three aims: First, she will identify values important to women’s decision-making about PrEP use during pregnancy and breastfeeding through a mixed methods formative study. Second, using this information and the results of a comprehensive needs assessment with pregnant women, their partners, and antenatal health care workers, she will develop a PrEP shared decision-making aid. Third, she will conduct a pilot trial to evaluate the effect of the shared decision-making intervention on the proximal cognitive endpoint of decisional conflict and explore the treatment effect on PrEP adherence. The training acquired by Dr. Hill through this timely study, in combination with didactic coursework, applied training, and mentorship will target the four training objectives: 1) to build expertise in medical decision-making with a focus on the development and evaluation of shared decision- making interventions; 2) to gain training in methods for the design, management, and analysis of trials to evaluate clinical interventions supporting the use of biomedical HIV prevention methods; 3) to master skills in the design of mixed methods studies and integration of mixed methods data for intervention design and evaluation; and 4) to develop the professional skills, expertise, and pilot data to facilitate her development toward research independence. Dr. Hill proposes to achieve these goals through a rigorous program of training and research to build upon and complement her training and experience in behavioral research for the primary prevention of HIV to fully prepare her for a career as an independent scientist in the field of global HIV/AIDS prevention.

摘要 暴露前预防(PrEP)是一种很有前途的工具，可以预防孕期和 产后期，是一整套预防母亲-- 向儿童提供艾滋病毒传播服务。然而，几乎没有战略来促进以人为中心的共享决策 关于在怀孕和哺乳期间使用PrEP，尽管这一决定很复杂，而且很重要 关于服药依从性的共同决策。在此指导下提出的培训和研究计划 研究科学家发展奖(K01)的申请将提供基本的培训和技能， 首席研究员劳伦·M·希尔博士需要在PrEP决策方面开始富有成效的职业生涯 研究、开发和评价行为干预措施，以促进和 坚持使用预防和治疗艾滋病毒的药物。此外，在整个研究过程中， 这一奖项的进程将对在以下背景下成功交付PrEP有意义的贡献 撒哈拉以南非洲的产前护理，以确保关于孕妇和妇女使用PrEP的决策 母乳喂养的妇女是以人为中心的，以鼓励适当和遵守使用。为了实现这一点，希尔博士 提出三个目标：第一，她将确定对妇女在使用PrEP期间做出决策的重要价值 通过孕乳混合方法进行形成性研究。第二，使用此信息和 对孕妇、她们的伴侣和产前保健进行全面需求评估的结果 她将开发一款PrEP共享决策辅助工具。第三，她将进行试点试验，以评估 共享决策干预对决策冲突近端认知终点的影响 探讨治疗对PrEP粘连的影响。希尔博士通过这次及时的研究获得的培训，在 与教学课程、应用培训和指导相结合，将以四个培训目标为目标：1) 建立医疗决策方面的专业知识，重点是开发和评估共享决策- 进行干预；2)接受设计、管理和分析试验以评估的方法方面的培训 支持使用生物医学艾滋病毒预防方法的临床干预措施；3)掌握设计技能 混合方法研究和混合方法数据的整合，用于干预设计和评估；以及4) 发展专业技能、专业知识和试验数据，以促进她向研究方向的发展 独立。希尔博士建议通过严格的培训和研究计划来实现这些目标 建立和补充她在艾滋病毒一级预防行为研究方面的培训和经验 为她作为全球艾滋病毒/艾滋病预防领域的独立科学家的职业生涯做好充分准备。