Asha Improving Health and Nutrition of Indian Women with AIDS and Their Children

阿莎改善印度艾滋病妇女及其子女的健康和营养

• 批准号: 9085393
• 负责人: Maria L. Ekstrand
• 金额: $ 56.61万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-23 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9085393
• 关键词: 8 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anthropometry; Biolectric Impedance; Biological Markers; Body Composition; Car Phone; Caring; Child; Child Care; Cholesterol; Clinical Trials Design; Collaborations; Communities; Computers; Consumption; Data; Data Collection; Development; Diet; Disease Progression; Environment; Face; Family member; Fatty acid glycerol esters; Federal Government; Focus Groups; Food; Food Supplementation; Food Supplements; Funding; Grant; Growth; Growth and Development function; HIV; HIV Seropositivity; Health; Immune; India; Infant; Intake; Intervention; Life; Light; Lipids; Longitudinal Studies; Macronutrients Nutrition; Malnutrition; Measures; Mental Health; Methodology; Methods; Minerals; Mission; Modeling; Monitor; Mothers; Muscle; National Institute of Mental Health; Nutrition Assessment; Nutritional; Nutritional Science; Nutritional Support; Outcome; Pilot Projects; Pregnant Women; Proteins; Published Comment; Publishing; Recommendation; Research; Research Personnel; Risk; Rural; Rural Health; Rural Population; Social Work; Supplementation; Technology; Testing; Time; Training; Treatment Protocols; Triglycerides; Underweight; Vitamins; Weight Gain; Wireless Technology; Woman; Women Status; Work; aged; antiretroviral therapy; arm; base; coping; depressive symptoms; design; experience; follow-up; improved; indexing; intervention program; lean body mass; meetings; muscle form; novel; nutrition; nutrition education; physical conditioning; post intervention; primary outcome; programs; scale up; social stigma; therapy adherence; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): Rural women living with AIDS (WLA) in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. Furthermore, they are generally underweight and malnourished, with adherence to antiretroviral therapy (ART) at levels lower than 50%. While the Indian Government's National Rural Health Mission utilizes a successful model to address the health needs of the rural population by training village women as Ashas (Accredited Social Work Activists) to enhance health of pregnant women and their infants, the focus on rural WLA needs to be significantly strengthened. U.S. and Indian collaborators recently completed an R34 pilot study which has demonstrated successful improvement in ART adherence, CD4 levels, and physical and mental health among rural Indian WLA. In total, 34 rural intervention WLA were supported by grant-trained, HIV-focused Ashas who provided assistance to WLA in decreasing barriers to ART adherence and provided protein supplementation compared to equal numbers of usual care WLA who received minimal protein supplementation. While very successful, our Asha pilot study monitored only WLA, despite the fact that many rural children are also at risk for delayed physical growth and psychomotor development. More importantly, we were not able to separate the nutritional component from the care and support component of the Asha, did not incorporate nutritional biomarkers, and were limited by only a six-month follow-up. In light of the mandate to advance both the science of nutrition and sustainability in real settings, our experienced team proposes to build on and extend our successful pilot work to meet this need, by assessing the incremental advantages of nutritional support to Asha care and support alone, and the impact of these programs on an index child (oldest between 3-8 years). In addition, we will take advantage of rural India's excellent mobile phone coverage and computer technology for both wireless data collection and data transfer. The proposed longitudinal study will use a 2x2 factorial design, specifically, 1) Asha support alone for WLA , vs. 2) Asha support for WLA + nutrition (food-based) training, vs. 3) Asha support for WLA + food supplementation, vs. 4) Asha support for WLA + nutrition training + food supplementation, to test the effects of nutrition training and/or food supplementation on primary outcomes of anthropometric parameters and immune status (CD4 levels) of the WLA at 6-, 12- and 18-month follow-up; and secondarily on ART adherence, psychological health, nutritional adequacy and lipid status of the WLA over time. Based upon reviewers' comments, among index children, we streamlined our assessments to include anthropometric parameters and psychomotor development; and among those HIV positive, immune status.

描述（由申请人提供）：印度感染艾滋病的农村妇女在获得和遵循治疗方案、照顾家庭成员和保持积极的心理健康方面继续面临深刻的挑战。此外，他们通常体重不足和营养不良，坚持抗逆转录病毒治疗的水平低于50%。虽然印度政府的全国农村保健特派团采用了一种成功的模式，通过培训乡村妇女成为Ashas（经认可的社会工作积极分子）来满足农村人口的保健需求，以增进孕妇及其婴儿的健康，但需要大大加强对农村社会工作的重视。美国和印度的合作者最近完成了一项R34试点研究，该研究成功地改善了印度农村WLA的抗逆转录病毒治疗依从性、CD4水平和身心健康。总共有34个农村干预WLA得到了资助培训的以艾滋病毒为重点的Ashas的支持，他们为WLA提供帮助，减少抗逆转录病毒治疗依从性的障碍，并提供蛋白质补充，与同等数量的接受最低蛋白质补充的常规护理WLA相比。虽然非常成功，但我们的Asha试点研究只监测了WLA，尽管事实上许多农村儿童也有身体发育和精神运动发育迟缓的风险。更重要的是，我们无法将Asha的营养成分与护理和支持成分分开，没有纳入营养生物标志物，而且只有六个月的随访。鉴于在现实环境中推进营养科学和可持续性的任务，我们经验丰富的团队建议通过评估营养支持对Asha护理和支持的增量优势，以及这些计划对指数儿童（最大3-8岁）的影响，来建立和扩展我们成功的试点工作，以满足这一需求。此外，我们将利用印度农村出色的移动电话覆盖和计算机技术进行无线数据收集和数据传输。拟议的纵向研究将使用一个2 x2的阶乘设计,具体地说,1)Asha支持WLA孤独,和2)Asha支持WLA +营养(食品类)训练,和3)亚莎支持WLA +补充食物,和4)亚莎支持WLA +营养培训+食品补充剂,来测试的影响营养培训和/或食品补充人体测量参数和免疫状态的主要成果(WLA CD4水平),6 - 12 - 18个月的随访;其次是抗逆转录病毒治疗依从性、心理健康、营养充足性和WLA血脂状况随时间的变化。根据审稿人的意见，在索引儿童中，我们简化了我们的评估，包括人体测量参数和精神运动发展；在HIV阳性人群中，免疫状态。