Developing an enhanced Mentor Mother strategy to improve prevention of mother-to-child transmission of HIV (PMTCT) outcomes

制定强化的导师母亲战略，以改善艾滋病毒母婴传播 (PMTCT) 的预防结果

• 批准号: 10651871
• 负责人: JAMES G CARLUCCI
• 金额: $ 15.4万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10651871
• 关键词: Acquired Immunodeficiency Syndrome; Address; Advocate; Affect; Africa South of the Sahara; Age Months; Caring; Cessation of life; Child; Clinic; Data; Development; Diagnostic; Educational workshop; Effectiveness; Event; Funding; Future; Goals; HIV; HIV Infections; Health; Human immunodeficiency virus test; Hybrids; Infant; Intervention; Interview; Kenya; Knowledge; Lactation; Leadership; Maternal and Child Health; Mentors; Mentorship; Meta-Analysis; Methods; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; Mothers; Outcome; Outcome Measure; Perception; Physicians; Prevention; Productivity; Research; Research Infrastructure; Research Methodology; Research Personnel; Resource-limited setting; Scientist; Services; Targeted Research; Testing; Vertical Disease Transmission; Vertical Transmission; Viral; Viremia; Woman; acceptability and feasibility; career development; design; effectiveness/implementation study; experience; follow-up; health care availability; implementation fidelity; implementation science; improved; low and middle-income countries; mortality; peer; person centered; pregnant; prevent; programs; randomized, clinical trials; research and development; risk minimization; skills

Prevention of mother-to-child transmission of HIV (PMTCT) programs offer a range of services to women living with HIV (WLHIV) to maintain their health and minimize the risk of their HIV-exposed infants (HEI) acquiring HIV. Despite widespread implementation of PMTCT services in sub-Saharan Africa, only two-thirds of WLHIV are virally suppressed, and nearly 40% of HEI are lost to follow-up or die by 18 months of age. There is a critical need to develop person-centered strategies targeting the factors preventing WLHIV and their HEI from realizing the full benefits of PMTCT care. Mentor Mothers (MM) are peer advocates who support WLHIV and HEI to promote improved PMTCT outcomes. While MM show promise in this regard, it is clear a “one size fits all” approach lacks responsiveness to the fact that some WLHIV and HEI need minimal support while others have specific needs. Research is needed to understand what strategies MM can use to address factors known to influence PMTCT outcomes, and how best to implement these strategies with high-fidelity in real-world settings. This proposal aims to address knowledge gaps and promote optimal PMTCT outcomes through person-centered development of an enhanced MM strategy that focuses on both the specific problems faced by WLHIV and HEI, as well as the real-world constraints of PMTCT programs. The central hypothesis is that this enhanced MM strategy can be implemented with high acceptability and fidelity, resulting in improved PMTCT outcomes. We will test this hypothesis through research targeted to the following Specific Aims. AIM 1: Use a participatory research approach to develop an enhanced MM strategy. In Sub-Aim 1a we will perform qualitative interviews with MM and WLHIV (both those with and without unfavorable PMTCT outcomes [attrition, viremia, or vertical transmission]) to identify: (i) feasible enhancements to the current MM strategy, (ii) barriers to optimizing the MM strategy, and (iii) approaches to overcoming these barriers. In Sub-Aim 1b we will conduct participatory design workshops with key implementation stakeholders (MM, PMTCT program leadership, and clinic staff) to develop an enhanced MM strategy with optimal potential for sustainable implementation. AIM 2: Conduct a pilot hybrid type 3 implementation-effectiveness study of the enhanced MM strategy. The enhanced MM strategy will be implemented at one clinic. We will use a mixed-methods approach to thoroughly assess acceptability, feasibility, and fidelity to the enhanced MM strategy. A pre-post assessment of key PMTCT outcome measures will provide preliminary effectiveness data. We expect this K23 proposal to advance my expertise in HIV implementation science, qualitative and mixed-methods research, and person- centered participatory design while also generating the compelling preliminary data needed to support a future R01 application for a pragmatic cluster randomized clinical trial of the enhanced MM strategy. These K23 research and career development activities will culminate in my transition to independence as an R01-funded, physician-scientist.

预防艾滋病毒母婴传播(母婴传播)方案为生活在 携带艾滋病毒(WLHIV)以维持健康并最大限度地减少接触艾滋病毒的婴儿(HEI)感染的风险 爱滋病毒。尽管在撒哈拉以南非洲广泛实施了防止母婴传播服务，但只有三分之二的艾滋病人 病毒抑制，近40%的HEI失去随访或在18个月大时死亡。有一个 迫切需要制定以人为本的战略，针对预防WLHIV及其高等教育的因素 实现预防母婴传播护理的全部好处。指导母亲(MM)是支持WLHIV和 高等教育促进预防母婴传播成果的改善。虽然MM在这一点上表现出了希望，但很明显，一种尺寸很适合 对于一些WLHIV和HEI需要最低限度的支持，而另一些人则需要最低限度的支持这一事实，所有方法缺乏响应性 有特定的需求。需要研究来了解MM可以使用什么策略来解决已知因素 影响预防母婴传播的结果，以及如何在现实世界中高保真地最好地实施这些战略 设置。这项提议旨在解决知识差距，并通过以下方式促进防止母婴传播的最佳成果 以人为本制定强化的MM战略，重点解决面临的两个具体问题 WLHIV和HEI，以及防止母婴传播方案的现实制约因素。中心假设是 这种增强的MM策略可以以高可接受性和保真度来实施，从而改进了 防止母婴传播的结果。我们将通过针对以下具体目标的研究来检验这一假设。目标1： 使用参与式研究方法来制定增强的MM战略。在子目标1a中，我们将执行 对MM和WLHIV(有和没有母婴传播不良结局的人)进行定性访谈 [消耗性、病毒血症或垂直传播])以确定：(1)对当前MM战略的可行改进，(2) 优化MM战略的障碍，以及(Iii)克服这些障碍的方法。在次级目标1b中，我们 将与主要实施利益攸关方(MM、防止母婴传播计划)共同举办参与式设计研讨会 领导力和诊所员工)制定具有最佳可持续发展潜力的增强MM战略 实施。目标2：开展试点混合类型3实施--增强MM的有效性研究 策略。强化MM战略将在一家诊所实施。我们将使用混合方法 彻底评估增强型MM战略的可接受性、可行性和保真度。上岗前评估 关键的防止母婴传播成果衡量标准将提供初步效力数据。我们预计这项K23提案将 提高我在艾滋病毒实施科学、定性和混合方法研究以及个人- 以参与式设计为中心，同时生成支持未来所需的令人信服的初步数据 R01应用于增强型MM策略的务实整群随机临床试验。这些K23 研究和职业发展活动将使我过渡到独立，成为一名R01资助的人， 医生兼科学家。