Implementing Comprehensive PMTCT and HIV Prevention for South African Couples

为南非夫妇实施全面的预防母婴传播和艾滋病毒预防

• 批准号: 8875095
• 负责人: Deborah Lynne Jones
• 金额: $ 32.19万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-29 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8875095
• 关键词: AIDS prevention; Address; Adherence; Adoption; African; Age-Months; Barrier Contraception; Behavior Therapy; Behavioral; Breast Feeding; Caring; Child; Clinic; Clinical; Communication; Community Health Centers; Conceptions; Country; Couples; Decision Making; Disclosure; Effectiveness of Interventions; Enrollment; Ensure; Epidemic; Family; Family Planning; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Policy; Human immunodeficiency virus test; Incidence; Individual; Infant; Infant Care; Intention; Intervention; Knowledge; Laboratories; Measures; Mothers; National Institute of Allergy and Infectious Disease; Nature; Newborn Infant; Outcome; Participant; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Postpartum Period; Pregnancy; Pregnant Women; Prevalence; Prevention; Process; Protocols documentation; Province; Public Health; Randomized; Recruitment Activity; Risk; Risk Reduction; Rural; Rural Community; Services; South Africa; Testing; Treatment Protocols; Vertical Disease Transmission; Vulnerable Populations; Wife; Woman; arm; base; cohort; design; effective therapy; evidence base; falls; feeding; improved; intimate partner violence; male; medication compliance; men; policy implication; postnatal; pregnant; prevent; programs; reproductive; safer sex; scale up; sex risk; social; social stigma; transmission process; uptake

DESCRIPTION (provided by applicant): In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available "prevention of mother-to-child transmission" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be "necessary, but not sufficient" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the "Vikela Umndeni: Protect Your Family" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.

描述（由申请人提供）：2010 年，在南非农村地区，只有三分之二在社区卫生中心寻求产前护理的艾滋病毒阳性孕妇充分利用了现有的“预防母婴传播”(PMTCT) 服务 (SADOH)。虽然鼓励男性伴侣的参与作为增加预防母婴传播的潜在手段，但男性却不愿意陪伴妻子/伴侣进行产前护理。 最近的研究普遍支持男性参与促进预防母婴传播，但这种参与的性质和影响尚不清楚且未经检验。同样明显的是，耻辱、信息披露和亲密伴侣暴力等因素对预防母婴传播的采用和保留护理构成了重大障碍，这表明男性的参与对于实现世界卫生组织婴儿艾滋病毒发病率<5%的目标可能是“必要的，但还不够”。可能需要采取额外措施来增加艾滋病毒阳性孕妇参与预防母婴传播的程度。 2011年，普马兰加省的艾滋病毒感染率全国最高（36.7%），农村诊所的婴儿艾滋病毒感染率高达50%。该省的预防母婴传播率是南非最低的（69%）。本申请提议扩大在普马兰加省进行的一项成功的 PEPFAR 支持的 PMTCT 夫妇干预试点研究（“Vikela Umndeni：保护您的家庭”），以纳入更具代表性的 HIV 阳性孕妇及其伴侣群体，主要目标是确定男性伴侣的参与加上行为干预是否会通过提高 ARV/PMTCT 的依从性来显着降低婴儿 HIV 发病率 产前和产后期间的协议，包括母乳喂养和计划生育。 拟议的研究将从 12 个随机分配的社区卫生中心（6 个实验中心，6 个对照中心）招募两组 HIV 阳性孕妇：a）没有男性伴侣参加的妇女（n = 720），然后 b）与男性伴侣一起参加的妇女（n = 720 对），以确定男性参与本身的影响或与行为 PMTCT 干预相结合是否可以显着减少婴儿艾滋病毒感染前、围产期和围产期的感染。 产后。这是我们的 打算通过让妇女和夫妇参与独特的、受控的、六次产前和产后风险降低/预防母婴传播促进干预措施，将普马兰加省预防母婴传播的参与率从目前的水平 (69%) 大幅提高到 90-95%，以解决阻碍女性和男性的预防母婴传播障碍（例如，耻辱、披露、亲密伴侣暴力、沟通、婴儿喂养做法、更安全的受孕） 充分利用他们及其婴儿可获得的治疗机会。根据我们试点研究令人鼓舞的初步结果，CHC 成功采用“Vikela Umndeni：保护您的家人”计划可能会对遏制南非农村最脆弱人群（艾滋病毒阳性孕妇及其婴儿）中的流行病产生重大公共卫生政策影响。