Understanding the role of food insecurity and depression in non-adherence to Option B+ among perinatal Kenyan women living with HIV: a Syndemics approach

项目总结/摘要 预防艾滋病毒母婴传播的战略可以减少垂直传播的风险 减少到2%以下，但难以坚持预防母婴传播的三大支柱（孕产妇抗逆转录病毒疗法; 母乳喂养;向婴儿提供抗逆转录病毒疗法预防;即，备选方案B+）导致儿童经母体感染艾滋病毒的比率很高， 撒哈拉非洲和欠佳的母婴健康。本研究的目标是：1）获得 了解粮食不安全（FI）和围产期抑郁症的影响和机制- 预防母婴传播方案B+不依从性的两个可修改的决定因素-相互作用以影响方案B+依从性， 2)完善我们的概念框架，以帮助干预发展，帮助母亲维持 B+依从性。候选人：我是一名护士科学家，有健康行为改变理论的背景， 在艾滋病毒感染情况下的婴儿喂养。我正在申请K23职业发展奖以获得培训， 导师，和研究经验，成为一个专家和独立的研究人员在理论为基础， 在艾滋病毒感染情况下影响母婴健康的多层次干预设计 设置.指导：我组建了一支在艾滋病毒方面具有丰富经验的优秀指导团队 在肯尼亚进行治疗和预防研究。 Drs.谢丽·韦瑟和克雷格·科恩将担任联合初选 在艾滋病毒治疗和预防、孕产妇和儿童健康、FI、 概念框架的完善，以及在肯尼亚制定和实施多层次干预措施。 我的共同导师和科学顾问完善了我的团队，带来了具体的内容和方法的专业知识， 都在美国和肯尼亚，包括：马洛里约翰逊博士（临床心理学，多层次 干预设计和评估;可行性实施; ART依从性）; Monica Gandhi博士（临床 伊丽莎白·布库西博士（肯尼亚艾滋病毒感染情况，孕产妇和新生儿感染情况， 坚持），Sera Young博士（母婴营养和FI，预防母婴传播干预考虑 Tor Neilands博士（心理学，定量方法，纵向数据的设计和分析）。 培训：我建议接受FI、围产期ART依从性、纵向定量研究设计和 分析，以及基于理论的多层次干预开发和评估。培训将实现 通过在肯尼亚的导师会议、课程、讲习班、指导性阅读和初步研究。 研究：拟议研究的目标是1）确定增加风险或预防的因素 HIV阳性妇女妊娠期和产后的FI和围产期抑郁症; 2）调查它们之间的相互作用 FI和围产期抑郁症对PMTCT指南依从性的影响 肯尼亚的围产期妇女; 3)开发多层次的干预和测试可行性，并进行全面测试， 计划在第5年提交R 01。

Project Summary/Abstract Strategies to prevent mother-to-child transmission (PMTCT) of HIV can reduce the risk of vertical transmission to less than 2%, but difficulties in adhering to the three pillars of PMTCT (maternal ART; exclusive breastfeeding; provision of ART prophylaxis to infant; i.e., Option B+) has led to high rates of MTCT in sub- Saharan Africa and suboptimal maternal and infant health. The goals of the proposed research are to 1) gain an understanding of the influences and mechanisms by which food insecurity (FI) and perinatal depression- two modifiable determinants of PMTCT Option B+ non-adherence-interact to impact Option B+ adherence and 2) refine our conceptual framework to aid in intervention development that assists mothers to maintain Option B+ adherence. Candidate: I am a nurse-scientist with a background in health behavior change theory and infant feeding in the context of HIV. I am applying for a K23 Career Development Award to obtain training, mentorship, and research experience to become an expert and independent investigator in theory-based, multi-level intervention design impacting maternal and infant health in the context of HIV in low-resource settings. Mentoring: I have put together an exceptional mentoring team with extensive experience in HIV treatment and prevention research in Kenya. Drs. Sheri Weiser and Craig Cohen will serve as co-Primary mentors and bring complementary expertise in HIV treatment and prevention, maternal and child health, FI, conceptual framework refinement, and development and implementation of multi-level interventions in Kenya. My co-mentors and scientific advisors round out my team to bring specific content and methods expertise and are based both in the U.S and in Kenya, including: Dr. Mallory Johnson (clinical psychology, multi-level intervention design and evaluation; feasibility implementation; ART adherence); Dr. Monica Gandhi (clinical management of HIV, objective ART adherence); Dr. Elizabeth Bukusi (HIV in the Kenyan context, maternal adherence), Dr. Sera Young (maternal and infant nutrition and FI, PMTCT considerations in intervention design), and Dr. Tor Neilands (psychology, quantitative methods, design and analysis of longitudinal data). Training: I propose to obtain training in FI, perinatal ART adherence, longitudinal quantitative study design and analysis, and theory-based multi-level intervention development and evaluation. Training will be achieved through mentor meetings, coursework, workshops, directed readings and primary research in Kenya. Research: The goals of the proposed research are to 1) identify factors that increase risk for or protect against FI and perinatal depression among HIV+ women during pregnancy and postpartum; 2) investigate the interplay of FI and perinatal depression on adherence to PMTCT guidelines over time among an existing cohort of perinatal women in Kenya; 3) develop a multi-level intervention and test feasibility with full scale testing in a planned R01 submission in year 5.