Integration of a collaborative care model for mental health services into HIV care for pregnant and postpartum women in Kenya (the Tunawiri Study)

常见的抑郁症和焦虑症(CMD)在肯尼亚人中很普遍，很大程度上没有得到治疗 孕妇和产后艾滋病毒携带者(PPWH)。慢性萎缩性疾病导致妇幼健康状况不佳 并导致PPWH缺乏艾滋病毒护理参与和病毒学失败。而有效的治疗方法 CMD的存在，在低收入和中等收入(LMIC)环境下的常规医疗保健中扩大治疗将需要 利益相关者参与以及有效性和实施数据，以了解扩大规模和可持续性。 我们的团队已经将其他有效的干预措施整合到肯尼亚的产前(ANC)和艾滋病毒护理中。我们现在 建议使用协作护理模式整合经过验证的心理健康服务，并结合低成本 强化循证干预(问题解决疗法)，同时针对已知的社会决定因素 PPWH的艾滋病毒相关健康(耻辱和IPV)。以目前艾滋病毒护理的多学科方法为基础 在肯尼亚，我们建议的协作护理模式(CCM)将利用现有的同伴导师母亲，非专科医生 行为护理经理和精神科护士；并将在 非国大/艾滋病毒护理团队。在企业信息系统(Exploration-Preparation-Implementation-Sustainment)框架的指导下， 总体研究目标是将围产期CMD的协作护理整合到#年的常规ANC/HIV服务中 肯尼亚，评估这种方法的成本和成本效益，并与政策制定者和决策者合作 确定纵向扩展的关键注意事项。具体地说，在目标1中，我们将确定背景障碍和 促进者将完善最佳集成模型，以便使用多个 方法数据收集(与提供者的焦点小组、对主要信息者的深入访谈和一家诊所 就绪检查表)。与我们的咨询委员会一起举办研讨会，咨询委员会由县和国家两级的利益攸关方组成， 将使我们能够将调查结果转化为与当地相关的CCM。在目标2中，我们将测试CCM PPWH 健康状况 在.期间 抑郁症 保留目标3，我们将 通过成本效益和传播研究改进CCM实施战略。我们会 进行成本计算和成本效益分析，并邀请政策制定者和决策者参与名义上的 成组技术过程，以阐明进一步扩大和维持CCM方法的因素。发现 这项研究将开发一个可扩展的模型，适用于其他LMIC环境，为全球艾滋病毒和艾滋病做出贡献 在实现孕产妇健康目标的同时，应对未经治疗的慢性阻塞性肺病的负担。 在产前护理中 在15个小学采用阶梯式楔形设计的混合型2实施-有效性试验中 肯尼亚西南部的护理设施。我们将介绍CCM对诊断为CMD的PPWH的护理 产前护理。产后12个月的共同初级健康结果将是：(1)从 或焦虑症状，和(2)持续病毒抑制的PPWH比例和 在爱滋病护理方面。关键的执行成果是可行性和可接受性。最后，在

Common mental disorders (CMD) of depression and anxiety are prevalent and largely untreated among Kenyan pregnant and postpartum women living with HIV (PPWH). CMD lead to poor maternal and child health outcomes and contribute to lack of HIV care engagement and virologic failure in PPWH. While efficacious treatments for CMD exist, scaling treatment within routine health care in low- and middle-income (LMIC) settings will require stakeholder engagement and both effectiveness and implementation data to inform scale up and sustainability. Our team has integrated other efficacious interventions into antenatal (ANC) and HIV care in Kenya. We now propose to integrate proven mental health services using a collaborative care model, combined with a low intensity evidence-based intervention (problem solving therapy), while targeting known social determinants of HIV-related health for PPWH (stigma and IPV). Building on the current multidisciplinary approach for HIV care in Kenya, our proposed Collaborative Care Model (CCM) will utilize existing peer mentor mothers, non-specialist behavioral care managers, and psychiatric nurses; and will incorporate a consultant psychiatrist into the ANC/HIV care team. Guided by the EPIS (Exploration-Preparation-Implementation-Sustainment) framework, the overall study goal is to integrate collaborative care for perinatal CMD within routine ANC/HIV services in Kenya, assess the costs and cost-effectiveness of this approach, and work with policy and decision makers to determine key considerations for scale-up. Specifically, in Aim 1, we will identify contextual barriers and facilitators to refine an optimal integration model for delivering collaborative care model using multi- method data collection (focus groups with providers, in-depth interviews with key informants, and a clinic readiness checklist). A workshop with our Advisory Board comprising both county and national level stakeholders, will allow us to translate findings into a locally relevant CCM. In Aim 2 we will test CCM PPWH health during depression retention Aim 3, we will refine CCM implementation strategies through cost-effectiveness and dissemination research. We will carry out costing and cost-effectiveness analysis and invite policy and decision-makers to participate in a nominal group technique process to elucidate factors for further scale up and sustainment of the CCM approach. Findings from this study will developing a scalable model adaptable to other LMIC settings, contributing to global HIV and maternal health goals while and addressing the burden of untreated CMD. in antenatal care for in a hybrid type 2 implementation-effectiveness trial using a stepped wedge design at 15 primary care facilities in southwestern Kenya . We will i ntroduce CCM care for PPWH diagnosed with CMD antenatal care. The co-primary health outcomes at 12 months postpartum will be (1) recovery from or anxiety symptoms in PPWH, and (2) proportion PPWH with sustained viral suppression and in HIV care. Key implementation outcomes are feasibility and acceptability. Finally, in