Promoting HIV health behaviors among pregnant couples in Zambia using an adaptive relationship strengthening intervention

项目摘要/摘要 应聘者：我是一名行为健康研究员，在艾滋病毒的社会决定因素方面具有专业知识，尤其是 强调撒哈拉以南非洲预防母婴传播(母婴传播)。我长期的职业生涯 目标是成为一所公共卫生学院的终身教授，拥有强大的研究组合，专注于 以家庭为基础的艾滋病毒防治战略。我以前的训练和经验使我能够 在不同的全球环境中对艾滋病毒的社会和行为方面进行严格的研究。然而，为了 成为我所在领域的顶级研究员，能够获得R01资金，我需要额外的培训和 在干预设计和评估方面的指导。K99/R00独立之路奖是一个合乎逻辑的奖项 在我之前的研究和培训的基础上取得了进展。在一支杰出的团队的指导下 研究人员，我将把我的培训阶段的奖项集中在职业发展活动上，以促进我的 过渡到能够在资源有限的情况下领导干预试验的独立行为艾滋病毒调查员 设置。指导阶段研究(K99，1-2年)：预防母婴传播计划的有效性取决于 优化孕妇和产后妇女对抗逆转录病毒治疗(ART)的依从性和持续性 全身心投入到护理中。在撒哈拉以南非洲的艾滋病毒高流行地区，如赞比亚，妇女失去了-- 在一连串的护理中以惊人的速度进行跟踪。背景因素，例如与 男性伴侣(关系满意度、沟通、冲突解决)是长期被忽视的影响 妇女预防母婴传播相关健康行为。该地区的夫妻咨询干预措施已经证明 成功地加强了关系并促进了一些艾滋病毒预防行为，这些夫妇感染了艾滋病毒 测试。为了测试夫妻咨询方法是否可以推广到赞比亚的母婴传播结果，我将 完善针对艾滋病毒阳性孕妇及其男性伴侣的夫妻咨询干预措施(目标1)。这个 干预基于我导师成功的夫妻咨询模式的元素，并使用了独特的 适应性设计。我将通过定性访谈完善拟议干预的内容和交付 与艾滋病毒阳性孕妇、她们的男性伴侣和服务提供者组成的焦点小组，同时参与 利益相关者，并在这种情况下建设我的研究能力。独立阶段研究(R00，3年- 5)：我将实施夫妇咨询干预的单点随机对照试验(n=238 夫妻；每臂119人)，并评估服务利用率和防止母婴传播成果指标，包括妇女的病毒 产后9个月的负荷，自我报告的ART依从性，以及在母婴传播护理中的保留(目标2)。我也会 确定干预对内部和人际机制的影响我假设是关于因果关系的 通过基线、3个月和9个月的行为调查影响预防母婴传播结局的途径(目标3) 产后。未来方向：这项研究的结果将提供证据，证明 夫妇咨询干预，以促进母婴传播的坚持和保留，这将被用来制定 更大规模的多点R01试验，具有较长期的艾滋病毒结果。

PROJECT SUMMARY/ABSTRACT Candidate: I am a behavioral health researcher with expertise in the social determinants of HIV, with a particular emphasis on prevention of mother-to-child transmission (PMTCT) in sub-Saharan Africa. My long-term career goal is to be a tenure-track professor in a school of public health with a robust research portfolio focused on family-based HIV prevention and treatment strategies. My prior training and experiences have enabled me to conduct rigorous research on the social and behavioral aspects of HIV in various global settings. However, to become a top investigator in my field capable of securing R01 funding, I require additional training and mentorship in intervention design and evaluation. The K99/R00 Pathway to Independence Award is a logical progression from my previous research and training. Under the mentorship of an exceptional team of researchers, I will focus my training phase of the award on career development activities that facilitate my transition to an independent behavioral HIV investigator capable of leading intervention trials in resource limited settings. Mentored Phase Research (K99, years 1-2): The effectiveness of PMTCT programs is dependent on optimizing pregnant and postpartum women’s adherence to antiretroviral therapy (ART) and sustained engagement in care. In high HIV prevalence settings of sub-Saharan Africa, such as Zambia, women are lost- to-follow up at alarming rates across the cascade of care. Contextual factors, such as relationship dynamics with male partners (relationship satisfaction, communication, conflict resolution), are a long-overlooked influence in women’s PMTCT-related health behaviors. Couples counseling interventions in the region have proven successful in strengthening relationships and promoting some HIV prevention behaviors, such couples HIV testing. In order to test if a couples counseling approach can extend to PMTCT outcomes in Zambia, I will refine a couples counseling intervention for HIV-positive pregnant women and their male partners (Aim 1). The intervention is based on elements of my mentors’ successful couples counseling models and uses a unique adaptive design. I will refine the content and delivery of the proposed intervention through qualitative interviews and focus groups with HIV-positive pregnant women, their male partners, and service providers, while engaging stakeholders and building my research capacity in this setting. Independent Phase Research (R00, Years 3- 5): I will implement a single-site randomized controlled trial of the couples counseling intervention (n=238 couples; 119 per arm) and assess service utilization and PMTCT outcome indicators, including women’s viral load at 9 months postpartum, self-reported ART adherence, and retention in PMTCT care (Aim 2). I will also establish the effect of the intervention on intra- and inter-personal mechanisms I hypothesize to be on the causal pathway influencing PMTCT outcomes (Aim 3) through behavioral surveys at baseline, 3 and 9 months postpartum. Future Directions: Findings from this study will provide evidence of the preliminary efficacy of the couples counseling intervention to promote PMTCT adherence and retention, which will be used to develop a larger multi-site R01 trial with longer-term HIV outcomes.