HIV and Perinatal Depression in Brazil

描述(由申请人提供)：鉴于艾滋病毒和严重抑郁障碍(MDD)的高全球共同发病率，随着全面的艾滋病毒护理超越生物医学考虑，包括精神障碍的同时治疗，了解这两种致残性疾病的负面协同影响变得越来越重要。我们的长期研究计划使用巴西南部感染艾滋病毒的母亲中的围产期抑郁(PD)作为干预研究艾滋病毒和MDD相互作用的初始范例。巴西在对这一复杂的全球问题进行前瞻性、重点和直截了当的研究方面具有几大优势：98%的孕妇得到免费有效的艾滋病毒治疗；艾滋病毒的母婴传播率为1%；我们的研究方案与NICHD资助的一个大型、成熟和成功的项目(国际现场开发倡议-NISDI)相结合，该项目旨在加强对拉丁美洲艾滋病毒感染妇女及其新生儿的生物医学研究基础设施；以及为孕妇提供高度集中的艾滋病毒治疗计划，使大量艾滋病毒感染妇女能够获得怀孕早期的护理。我们的R21应用是R01最终应用于大型多臂随机对照试验的一部分，该试验针对接受有效ARV治疗的女性帕金森病患者进行干预治疗。这一跨国家、多学科的项目将有助于收集有关帕金森病患病率的必要试点数据，为后续干预计划确定风险因素和杠杆点，为将帕金森病研究纳入NISDI制定有效的战略，以及在当地人口中调整和验证筛查工具。利用巴西南部卡西亚斯大学医学院的NISDI基础设施，我们将在为期24个月的研究期间，在阿雷格里港(人口约1000万)进行相互关联的研究。研究1：描述当地抑郁、应对策略、社会支持和耻辱概念的定性研究；研究2和3：在巴西联邦两家大型医院的两个时间点(怀孕中期和产后3-4个月)对450名艾滋病毒感染者和450名对照艾滋病毒未感染妇女进行PD筛查，以确定PD患病率，并增加对相关心理社会因素(应激性生活事件的频率、支持系统、应对和耻辱)的影响的了解。我们试图利用寻求产前护理和新生儿健康访问的高倾向，这往往是妇女中经常被边缘化的艾滋病毒感染人口的特征，否则她们可能无法学习。我们希望利用这个机会开发有效的筛查和可持续的PD干预计划，而此时全球和国家艾滋病毒政策的变化将使这些工具对艾滋病毒的全面护理变得越来越重要。 与公共卫生相关：目前，我们对感染艾滋病毒的育龄妇女中抑郁症的性质知之甚少；特别是在有效的艾滋病毒治疗方案的背景下，这些方案使受感染的妇女活得更长，并显著减少了病毒的母婴传播。这项研究将通过研究与艾滋病毒感染有关的围产期抑郁症的性质、重要性和原因开始解决这一问题，并将用于开发可行和可持续的方案来治疗围产期抑郁症，其疗效将在未来的赠款申请中进行测试。

DESCRIPTION (provided by applicant): Given the high global co-morbidity of HIV and major depressive disorder (MDD), understanding the negative synergistic effects of these two disabling conditions is increasingly important as comprehensive HIV care moves beyond biomedical concerns to include concurrent treatment of mental disorders. Our long-term research program uses perinatal depression (PD) in HIV-infected mothers in southern Brazil as an initial paradigm for intervention studies of the interaction of HIV and MDD. Brazil offers several major advantages for conducting prospective, focused, straight-forward studies of this complex global problem: > 98% of pregnant women receive free effective HIV-treatment; mother-to-child HIV transmission rates are <1%; integration of our research program with a large, well-established and successful NICHD-funded program (International Site Development Initiative - NISDI) that seeks to strengthen biomedical research infrastructure for studying HIV-infected women and their newborn children in Latin America; and a highly centralized HIV treatment program for pregnant women, providing access to large numbers of HIV-infected women presenting for care early in their pregnancies. Our R21 application is a segue to an eventual R01 application for a large multi-arm randomized controlled trial of interventions for treatment of PD among women undergoing effective ARV treatment. This present bi-national, multidisciplinary project will enable collection of requisite pilot data on prevalence of PD, identification of risk factors and leverage points for subsequent intervention programs, development of effective strategies for integration of studies of PD into NISDI, and adaptation and validation of screening instruments among the local population. Using the NISDI infrastructure at the Faculty of Medicine, University of Caxias in southern Brazil we will conduct interconnected studies in Porto Alegre (population ~10 million) during the 24-month study period. Study 1: a qualitative study to delineate local concepts of depression, coping strategies, social support, and stigma; and Studies 2 and 3: PD screenings among 450 HIV-infected and 450 control HIV-uninfected women at two time points (during the second trimester of pregnancy and three-four months post-partum) at two large Brazilian Federation hospitals to establish PD prevalence rates and increase understanding of the impact of associated psychosocial factors (frequency of stressful life events, support systems, coping and stigma). We seek to use the high proclivity for seeking prenatal care and newborn health visits that frequently characterizes an often marginalized HIV-infected population of women who may otherwise not be available for study. We hope to use this opportunity to develop effective screening and sustainable PD intervention programs at a time when changes in global and national HIV policies will render such tools of increasing importance to comprehensive care of HIV. PUBLIC HEALTH RELEVANCE: Currently we know little about the nature of depression among HIV-infected women of child-bearing age; particularly in the context of effective HIV treatment programs, which are allowing infected women to live longer and significantly reducing mother-to-child transmission of the virus. This research will begin to address this issue by studying the nature, importance and causes of perinatal depression related to HIV infection and will be used to develop feasible and sustainable options for treating perinatal depression whose efficacy will be tested in a future grant submission.