HIV and Perinatal Depression in Brazil

描述（由申请人提供）：鉴于HIV和重度抑郁症（MDD）的高全球共发病率，了解这两种致残性疾病的负面协同效应越来越重要，因为全面的HIV护理超越了生物医学问题，包括同时治疗精神障碍。我们的长期研究计划使用围产期抑郁症（PD）在艾滋病毒感染的母亲在巴西南部作为艾滋病毒和MDD的相互作用的干预研究的初始范例。巴西在对这一复杂的全球问题进行前瞻性、重点突出和直截了当的研究方面具有几大优势：98%以上的孕妇获得免费有效的艾滋病毒治疗;母婴艾滋病毒传播率低于1%;我们的研究计划与一个大型，NICHD资助的一个完善和成功的项目（国际网站开发倡议- NISDI），旨在加强生物医学研究基础设施，以研究拉丁美洲感染艾滋病毒的妇女及其新生儿;高度集中的孕妇艾滋病毒治疗方案，为大量在怀孕早期前来接受治疗的艾滋病毒感染妇女提供治疗机会。我们的R21申请是最终R 01申请的后续，用于在接受有效ARV治疗的女性中进行PD干预治疗的大型多臂随机对照试验。目前的两国，多学科的项目将使必要的试点数据收集的患病率PD，识别的风险因素和杠杆点，为后续的干预计划，制定有效的战略，PD的研究纳入NISDI，适应和验证的筛选工具在当地人口。利用巴西南部卡希亚斯大学医学院的NISDI基础设施，我们将在为期24个月的研究期间在波尔图阿莱格雷（人口约1000万）进行相互关联的研究。研究1：一项定性研究，描述当地的抑郁症概念，应对策略，社会支持和耻辱;和研究2和3：在两个时间点对450名HIV感染和450名对照HIV未感染妇女进行PD筛查（怀孕中期和产后3 - 4个月）在两个大型巴西联邦医院建立PD患病率，并增加对相关心理社会因素影响的理解（压力性生活事件的频率、支持系统、应对和耻辱）。我们试图利用寻求产前护理和新生儿健康检查的高倾向，这通常是经常被边缘化的艾滋病毒感染妇女人口的特点，否则她们可能无法参加研究。我们希望利用这个机会，制定有效的筛查和可持续的PD干预计划的时候，在全球和国家艾滋病毒政策的变化将使这些工具越来越重要的艾滋病毒的综合护理。 公共卫生相关性：目前，我们对感染艾滋病毒的育龄妇女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，这些方案使感染妇女寿命更长，并大大减少了病毒的母婴传播。这项研究将开始通过研究与艾滋病毒感染有关的围产期抑郁症的性质、重要性和原因来解决这一问题，并将用于制定治疗围产期抑郁症的可行和可持续的选择，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.