Reducing psychological barriers to PrEP persistence among pregnant and postpartum women in Cape Town, South Africa

背景：南非（SA）的孕妇感染艾滋病毒的风险很高。暴露前预防 在怀孕期间使用PrEP（PrEP）在预防艾滋病毒方面既安全又有效。然而，创伤后压力 （与亲密伴侣暴力和/或其他创伤相关）和抑郁症对PrEP产生负面影响 女性在SA中的地位。解决创伤后应激障碍和抑郁症可能会改善PrEP 粘附和持久性（即，持续的PrEP坚持随着时间的推移）在怀孕和哺乳期间， 这是艾滋病风险急剧增加的时期。本提案的总体目标是开发和测试 认知行为干预的可行性和可接受性，针对共同的潜在因素， 创伤后应激和抑郁症，以改善怀孕期间的PrEP依从性和持久性， 产后过渡期候选人：我是一名临床心理学家，也是马萨诸塞州的博士后研究员 综合医院/哈佛医学院。我正在申请为期五年的K23职业发展奖， 培训，指导和研究经验，使我能够成为（1）独立调查员 （2）一名专家，负责减少低收入妇女预防艾滋病毒的心理障碍， 资源设置。指导：Conall O 'Cleiigh博士将担任我的主要导师;他带来了 在全球范围内制定艾滋病毒预防和干预措施的社会心理方面。Christina Psaros博士 和Jessica Haberer，两位共同导师，将提供定性数据分析的指导，因为它适用于干预 为中低收入环境制定和实施科学框架。兰登·梅尔医生 我在南非的共同导师约翰·乔斯卡和露西娅·奈特将提供生物医学艾滋病预防方面的指导 在怀孕/产后期间使用的战略，针对南非情况的干预措施的制定，以及 产前诊所环境中的干预可持续性。生物统计学家罗伯特帕克博士将担任 顾问。培训：为制定和实施干预措施进行定性分析的具体培训， 怀孕期间的艾滋病毒预防和资源有限环境下的心理社会治疗发展将是 通过密集的直接指导，课程，研讨会和SA的主要研究实现。本次培训 和研究经验将使我能够支持妇女的精神和性健康的风险，获得 艾滋病。研究：该项目的具体目标是（1）探索创伤后应激反应的机制， 和抑郁症的影响PrEP坚持和坚持在怀孕期间通过定性访谈;（2）发展 并进行一个简短的PrEP依从性和持久性干预的概念验证测试， 创伤后应激障碍和抑郁症常见的心理机制对PrEP使用的负面影响， 并建立行为技能，以提高自我保健;（3）评估的可行性和可接受性， 干预，这将被纳入产前保健，在一个试点随机对照试验。我们将使用这个 形成性研究申请R 01级补助金，以评估干预措施的功效和有效性。

Background: Pregnant women in South Africa (SA) are at high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) use during pregnancy is both safe and effective in preventing HIV. However, posttraumatic stress (associated with intimate partner violence and/or other traumas) and depression negatively impact PrEP adherence among women in SA. Addressing posttraumatic stress and depression will likely improve PrEP adherence and persistence (i.e., sustained PrEP adherence over time) during pregnancy and breastfeeding, which are periods of dramatically increased HIV risk. The overarching goal of this proposal is to develop and test the feasibility and acceptability of a cognitive behavioral intervention that targets common underlying factors of posttraumatic stress and depression to improve PrEP adherence and persistence during pregnancy and the postpartum transition. Candidate: I am a clinical psychologist and a postdoctoral fellow at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain the training, mentorship, and research experience that will enable me to become (1) an independent investigator at the R01 level and (2) an expert in reducing the psychological barriers to HIV prevention among women in low- resource settings. Mentoring: Dr. Conall O’Cleirigh will serve as my primary mentor; he brings expertise in the psychosocial aspects of HIV prevention and intervention development for global contexts. Drs. Christina Psaros and Jessica Haberer, both co-mentors, will offer guidance on qualitative data analysis as it applies to intervention development and implementation science frameworks for low- and middle-income settings. Drs. Landon Myer, John Joska, and Lucia Knight, my SA-based co-mentors, will provide mentorship on biomedical HIV prevention strategies for use during pregnancy/postpartum, intervention development for the South African context, and intervention sustainability within the antenatal clinic setting. Dr. Robert Parker, a biostatistician, will serve as a consultant. Training: Specific training in qualitative analysis for intervention development and implementation, HIV prevention during pregnancy, and psychosocial treatment development for resource-limited settings will be achieved through intensive direct mentorship, coursework, workshops, and primary research in SA. This training and research experience will enable me to support the mental and sexual health of women at risk for acquiring HIV. Research: The specific aims of the project are to (1) explore the mechanisms by which posttraumatic stress and depression impact PrEP adherence and persistence during pregnancy via qualitative interviews; (2) develop and conduct a proof-of-concept test of a brief PrEP adherence and persistence intervention that reduces the negative impact of psychological mechanisms common to posttraumatic stress and depression on PrEP use, and builds behavioral skills to improve self-care; and (3) evaluate the feasibility and acceptability of the intervention, which will be integrated into antenatal care, in a pilot randomized controlled trial. We will use this formative research to apply for an R01-level grant to evaluate the efficacy and effectiveness of the intervention.