HIV and Perinatal Depression in Brazil

描述（由申请人提供）：鉴于全球HIV和重度抑郁症（MDD）的高发病率，了解这两种致残状况的负面协同效应变得越来越重要，因为全面的HIV护理从生物医学关注转向包括精神障碍的同时治疗。我们的长期研究计划使用巴西南部HIV感染母亲的围产期抑郁症（PD）作为HIV和MDD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、直截了当的研究方面具有几项主要优势：98%的孕妇获得免费有效的艾滋病毒治疗；艾滋病毒母婴传播率<1%；将我们的研究方案与一个大型的、建立良好的、成功的由联合国儿童基金会资助的方案（国际站点开发倡议- NISDI）结合起来，该方案旨在加强研究拉丁美洲感染艾滋病毒的妇女及其新生儿的生物医学研究基础设施；高度集中的孕妇艾滋病毒治疗方案，使大量感染艾滋病毒的妇女能够在怀孕早期接受治疗。我们的R21申请是对最终R01申请的一个延续，即在接受有效抗逆转录病毒治疗的妇女中进行干预治疗PD的大型多组随机对照试验。目前，这个两国、多学科的项目将收集PD患病率的必要试点数据，确定风险因素和后续干预计划的影响点，制定将PD研究纳入NISDI的有效策略，并在当地人群中适应和验证筛查工具。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：定性研究描述抑郁、应对策略、社会支持和病耻感的本地概念；研究2和研究3：在巴西两家大型联邦医院的两个时间点（妊娠中期和产后3 - 4个月）对450名hiv感染妇女和450名对照hiv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（压力生活事件的频率、支持系统、应对和耻辱）影响的理解。我们试图利用寻求产前护理和新生儿健康检查的高倾向，这往往是被边缘化的艾滋病毒感染妇女群体的特征，否则她们可能无法进行研究。我们希望利用这个机会，在全球和国家艾滋病政策的变化将使这些工具对艾滋病的全面护理越来越重要的时候，开发有效的筛查和可持续的PD干预项目。

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.