Patient navigation to improve outcomes among low-income women in the postpartum period

项目总结 怀孕是包括疫苗在内的预防性卫生干预措施的关键机会之窗。然而，疫苗 犹豫不决是一个众所周知的全球现象。目前推荐的疫苗在孕期的摄入量 (流感和破伤风、白喉和百日咳[Tdap])是次优的，只有50%的人接受 推荐的疫苗。疫苗接种方面存在差异，但这一问题尚未得到彻底调查 从病人的角度来看。对于那些认为自己是种族或种族的孕妇的观点，我们知之甚少 少数民族或携带艾滋病毒的孕妇(WLHIV)，这两人的代表性都很低， 研究不足的人群，他们因流感等疾病而出现并发症的风险更大。 此外，新冠肺炎大流行和将一种新的疫苗引入卫生保健提出了迫切需要 了解推动疫苗接种的因素，特别是在弱势群体中，如种族和民族 少数民族孕妇和产后妇女与WLHIV。早期数据表明，孕妇和 免疫功能受损的人--如艾滋病毒携带者--患病和死亡的风险增加。 来自新冠肺炎。了解这些人群不断演变的观点将为教育和 提高孕期接种疫苗接种率和减少疫苗接种差距的咨询策略。 目标1将评估少数民族孕妇和产后WLHIV的经历和偏好 以及孕期接种标准护理疫苗的艾滋病毒血清阴性妇女。个人面谈 将讨论关于怀孕期间常规疫苗接种的看法、经历和决定， 包括信任、访问和知识的问题。此外，分析还将比较日常工作的视角 可能因艾滋病毒状况而不同的疫苗。目标2将考察这群人对这部小说的看法 新冠肺炎疫苗。我们将探索动机和社会文化基础，以澄清这些担忧， 关于孕期接种新冠肺炎疫苗的信念和经验。我们还将比较 艾滋病病毒携带者和非艾滋病妇女的观点，我们将分析人们对新冠肺炎的态度差异 疫苗与标准护理疫苗。为了实现这些目标，我们将招募40名怀孕或新近怀孕的人 产后妇女与NICHD资助的导航新母亲2研究和 西北纪念医院妇女传染病项目。感染和不携带艾滋病毒的妇女将成为 人口统计上的相似，以关注研究不足的女性的多样化群体，这些女性大多是低收入- 收入和来自种族或少数族裔的收入。 这项建议旨在满足对态度和态度进行系统、深入和公正评估的未得到满足的需求 未被研究的妇女群体对怀孕期间常规和新型疫苗接种的偏好。 该项目直接与《跨NIH妇女健康研究战略计划》的目标和目的相一致 将解决不同妇女群体中健康的社会决定因素的交叉问题。

PROJECT SUMMARY Pregnancy is a critical window of opportunity for preventive health interventions, including vaccines. Yet, vaccine hesitancy is a known global phenomenon. Uptake of the currently recommended vaccines in pregnancy (influenza and tetanus, diphtheria, and pertussis [TDaP]) is suboptimal, with only 50% of individuals receiving recommended vaccines. Disparities in vaccine uptake exist, yet this issue has not been thoroughly investigated from the patient perspective. Little is known about the perspectives of pregnant women who identify as racial or ethnic minorities or pregnant women living with HIV (WLHIV), both of whom are underrepresented and understudied populations who are at greater risk of complications from conditions such as influenza. Additionally, the COVID-19 pandemic and introduction of a novel vaccine to health care presents an urgent need to understand factors driving vaccination uptake, particularly in vulnerable populations such as racial and ethnic minority pregnant and postpartum women and WLHIV. Early data suggest that pregnant women and immunocompromised people – such as those living with HIV - are at increased risk of morbidity and mortality from COVID-19. Understanding the evolving perspectives of these populations will inform educational and counseling strategies to enhance vaccination uptake in pregnancy and reduce vaccination disparities. Aim 1 will assess the experiences and preferences of racial and ethnic minority pregnant and postpartum WLHIV and HIV-seronegative women with regard to standard of care vaccines during pregnancy. Individual interviews will address perceptions, experiences, and decisions surrounding routine vaccinations during pregnancy, including issues of trust, access, and knowledge. Analyses will additionally compare perspectives on routine vaccines that may differ by HIV status. Aim 2 will examine the perspectives of this population on the novel COVID-19 vaccine. We will explore motivations and sociocultural underpinnings that may clarify the concerns, beliefs, and experiences surrounding COVID-19 vaccination in pregnancy. We will additionally compare the perspectives of women with and without HIV, and we will analyze differences in attitudes for the COVID-19 vaccine versus standard of care vaccines. To accomplish these aims, we will recruit 40 pregnant or recently postpartum women in partnership with the NICHD-funded Navigating New Motherhood 2 study and the Northwestern Memorial Hospital Women’s Infectious Diseases Program. Women with and without HIV will be demographically similar in order to focus on a diverse population of understudied women who are largely low- income and from a racial or ethnic minority. This proposal aims to fill an unmet need for a systematic, in-depth, and unbiased evaluation of the attitudes and preferences of understudied populations of women regarding routine and novel vaccinations during pregnancy. This project directly aligns with the Trans-NIH Strategic Plan for Women’s Health Research goals and the aims will address intersections of social determinants of health in diverse populations of women.