Traditional Healers as Adherence Partners for PLHIV in Rural Mozambique

 描述(由申请人提供)：此职业奖励申请旨在促进Audet博士作为一名独立的全球卫生研究人员的职业发展。在NIMH K01奖项的支持下，Audet博士计划开发一个协调的卫生系统，将互补性和对抗性提供者联系起来，以改善资源不足国家的艾滋病毒结果。Audet博士的目标是改善和正规化对抗疗法提供者和替代提供者之间的关系，以提高艾滋病毒患者的依从性，重点放在莫桑比克。莫桑比克中部的高艾滋病毒感染率(12.5%)，再加上患者的高随访率(50%)，造成了公共卫生危机。坚持艾滋病毒治疗的主要障碍是害怕披露/污名、患者误解/不相信他们的诊断、卫生机构感觉不到的治疗以及患者对传统药物的偏好。治疗师处于支持患者坚持治疗的理想地位：(1)保持保密和/或协助伴侣披露；(2)使用当地语言和当地文化背景解释艾滋病毒；(3)在临床现场倡导他们的健康；以及(4)确保患者不放弃对传统药物的护理。申请者Carolyn Audet博士是范德比尔特大学的助理教授，她一直站在莫桑比克试图以文化上适当的方式聘用治疗师的最前线。她对与治疗师合作以改善患者健康状况的兴趣促使制定了国家级卫生部转诊表格，因为治疗师是社区卫生人员中的“任务转移”。在与卫生部的合作下，她制定了经过实地测试的转介表格和培训方案，确定了治疗师可以有效地与卫生部合作。她也是两项赠款的主办人：一项是疾控中心资助的赠款，用于改善莫桑比克农村临床医生积极预防信息的临床传递；另一项是欢跃健康护理赠款，旨在吸引男性和传统助产士，以提高感染艾滋病毒的孕妇接受抗逆转录病毒治疗的能力。作为对NIMH宣布的K01项目的回应，奥迪特博士为追求独立科学家的职业生涯寻找“受保护的时间”。她将在范德比尔特大学和密歇根大学(与她的共同小学导师Amico博士一起)参加关于设计和实施健康信息干预措施的额外培训，以解决根深蒂固的文化信仰和行为。Audet博士的目标是为当前资助的计划提供现场研究领导，并在合作机构进行持续的研究培训和能力建设工作，她与合作机构的合作伙伴关系将侧重于在传统治疗师和医疗保健系统之间发展可持续、实用和有效的关系。

 DESCRIPTION (provided by applicant): This career award application seeks to foster the development of Dr. Audet's career as an independent global health researcher. With the support from an NIMH K01 award, Dr. Audet plans to develop a harmonized health system linking complementary and allopathic providers to improve HIV outcomes in countries in under- resourced countries. Dr. Audet's goals are to improve and formalize relationships between allopathic and alternative providers to improve adherence among patients with HIV disease, with a geographic focus in Mozambique. High rates of HIV infection in central Mozambique (12.5%) coupled with high rates of loss to follow up among patients (50%) have resulted in a public health crisis. Major barriers to HIV treatment adherence have been fear of disclosure/ stigma, patient misunderstanding/ not believing their diagnosis, poor perceived treatment at the health facility and patient preference for traditional medicine. Healers are ideally positioned to support patient adherence by: (1) maintaining confidentiality and/or assisting with partner disclosure; (2) explaining HIV using local languages and in local cultural context; (3) advocating for their health at clinical sites; and (4) ensuring patients do not abandon care for traditional medicines. The applicant, Dr. Carolyn Audet, an Assistant Professor at Vanderbilt University, has been in the forefront of Mozambique's attempt to engage healers in a culturally appropriate manner. Her interest in working with healers to improve patient health outcomes has led to the development of National level Ministry of Health referral forms, as healers are `task shifting' int community health agents. In collaboration with the Ministry of Health, she has field-tested referral forms and training programs, establishing that healers can effectively partner with the Ministry. She is also the PI of two grants: a CDC-funded grant to improve clinical delivery of positive prevention messages among clinicians in rural Mozambique and a ViiV Health Care grant to engage men and traditional birth attendants to improve uptake of ART among HIV infected pregnant women. Responsive to NIMH's K01 program announcement, Dr. Audet seeks `protected time' for pursuing a career as an independent scientist. She will engage in additional training in the design and implementation of health messaging interventions to address culturally entrenched beliefs and behaviors at Vanderbilt University and University of Michigan (with her co-primary Mentor Dr. Amico). Dr. Audet aims to provide on-site research leadership to current funded initiatives coupled with ongoing research training and capacity building efforts at the collaborating institutions, with whom her partnerships will focus on developing a sustainable, practical, and effective relationship between traditional healers and the health care system.