Implementing Comprehensive PMTCT and HIV Prevention for South African Couples

为南非夫妇实施全面的预防母婴传播和艾滋病毒预防

• 批准号: 8868158
• 负责人: Deborah Lynne Jones
• 金额: $ 48.36万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-29 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8868158
• 关键词: AIDS prevention; Address; Adherence; Adoption; African; Age-Months; Barrier Contraception; Behavior Therapy; Behavioral; Breast Feeding; Caring; Child; Clinic; Clinical; Communication; Community Health Centers; Conceptions; Country; Couples; Decision Making; Disclosure; Effectiveness of Interventions; Enrollment; Ensure; Epidemic; Family; Family Planning; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Policy; Human immunodeficiency virus test; Incidence; Individual; Infant; Infant Care; Intention; Intervention; Knowledge; Laboratories; Measures; Mothers; National Institute of Allergy and Infectious Disease; Nature; Newborn Infant; Outcome; Participant; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Prevalence; Prevention; Process; Protocols documentation; Province; Public Health; Randomized; Recruitment Activity; Risk; Risk Reduction; Rural; Rural Community; Safe Sex; Services; South Africa; Testing; Treatment Protocols; Vertical Disease Transmission; Vulnerable Populations; Wife; Woman; arm; base; cohort; design; effective therapy; evidence base; falls; feeding; improved; intimate partner violence; male; medication compliance; men; policy implication; postnatal; pregnant; prevent; programs; reproductive; scale up; sex risk; social; social stigma; transmission process; uptake

DESCRIPTION (provided by applicant): In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available "prevention of mother-to-child transmission" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be "necessary, but not sufficient" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the "Vikela Umndeni: Protect Your Family" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.

描述(申请人提供)：在南非农村，2010年，在社区卫生中心寻求产前护理的艾滋病毒携带者孕妇中，只有三分之二充分利用了现有的“预防母婴传播”(母婴传播)服务(Sadoh)。虽然鼓励男性伴侣参与，将其作为增加母婴传播的潜在手段，但男性一直不愿陪同妻子/伴侣进行产前护理。最近的研究普遍支持男性参与促进防止母婴传播，但这种参与的性质和影响尚不清楚，也未经检验。同样清楚的是，耻辱、披露和亲密伴侣暴力等因素对防止母婴传播感染和保留护理构成了重大障碍，这表明男性的参与可能是实现世卫组织婴儿艾滋病毒发病率5%的目标的“必要的，但不充分的”。可能需要采取更多措施，以增加艾滋病毒阳性孕妇参与预防母婴传播。2011年，姆普马兰加省的艾滋病毒感染率是全国最高的(36.7%)，农村诊所的婴儿艾滋病毒感染率高达50%。该省的防止母婴传播感染率一直是南非最低的(69%)。这项申请建议扩大在姆普马兰加省进行的一项成功的由PEPFAR支持的防止母婴传播夫妇干预试点研究(“Vikela Umndeni：保护您的家庭”)，以包括更具代表性的艾滋病毒阳性孕妇及其伴侣群体，主要目标是确定男性伴侣的参与加上行为干预是否会通过在产前和产后增加对抗逆转录病毒/防止母婴传播感染方案(包括母乳喂养和计划生育)的遵守程度来显著降低婴儿艾滋病毒发病率。这项拟议的研究将招募从12个随机分配的社区卫生中心(6个实验中心，6个对照中心)招募的两组艾滋病毒阳性孕妇：a)没有男性伴侣参加的妇女(n=720)，然后是b)与男性伴侣一起参加的妇女(n=720对夫妇)，以确定男性参与本身或与预防母婴传播行为干预相结合的影响是否可以显著降低婴儿出生前、围产期和产后的艾滋病毒感染。这是我们的 打算将姆普马兰加省预防母婴传播的参与率从目前的水平(69%)大幅提高到90%-95%，方法是让妇女和夫妇参加一项独特的、受控的、六期的产前和产后降低风险/防止母婴传播宣传干预措施，以解决防止母婴传播的障碍(例如，耻辱、披露、亲密伴侣暴力、交流、婴儿喂养做法、更安全的概念)，这些障碍阻止妇女和男子充分利用他们和他们的婴儿可获得的治疗机会。根据我们试点研究的令人鼓舞的初步结果，CHC成功地采用了“Vikela Umndeni：保护您的家庭”计划，对于控制南非农村最脆弱的人群：HIV+孕妇及其婴儿的流行病，可能会产生重大的公共卫生政策影响。