Mother and Infant Retention for Health (MIR4Health)

说明(由申请人提供)：消除艾滋病毒母婴传播需要确定有效、可行、成本效益高和可推广的方式 将感染艾滋病毒的孕妇及其婴儿保留在预防母婴传播(PMTCT)和整个预防母婴传播(PMTCT)级联的艾滋病毒护理和治疗计划中。我们提出了母婴保育促进健康(MIR4Health)，这是一项创新的实施科学研究，重点是确定一种有效的多组成部分战略，以改善肯尼亚涅扎纳省新发现的艾滋病毒感染孕妇获得母婴健康服务的联系和留存。这项研究是一项随机试验，旨在比较使用积极患者随访(APFU)的新策略与目前的护理标准(SOC)相比的有效性，该策略使用积极的患者随访(APFU)来吸引和保留新发现的感染艾滋病毒的怀孕妇女及其婴儿在产后保留。拟议的APFU包括一系列循证干预措施，包括健康教育、提供电话和短信服务预约提醒、主动跟踪患者的联系和保留，以及个性化的保留和遵守支持。主要目的是评估APFU加SOC和SOC在产后6个月母婴保留的综合结果上的有效性。此外，我们将研究干预措施对其他关键结果的有效性，包括孕妇第二次产前检查的次数；CD4+细胞计数和艾滋病毒RNA病毒载量的变化；感染艾滋病毒的婴儿在6周时进行聚合酶链式反应(PCR)检测；以及妇女和婴儿坚持服用处方的抗逆转录病毒方案。MIR4 Health的特点是有几项创新，包括认识到新发现的感染艾滋病毒的孕妇特别容易在预防母婴传播内留存不良，必须将母亲和儿童留在照料中，以确保最佳的健康结果。采用一种可行、务实的方法，解决已知障碍，以循证干预措施为基础，如果成功，有可能推广，这有助于肯尼亚努力消除新的儿科感染和保护产妇健康。

DESCRIPTION (provided by applicant): Elimination of maternal to child transmission of HIV will require identification of effective, feasible, cost- effective and scalable ways to engage and retain HIV-infected pregnant women and their infants in prevention of mother to child transmission (PMTCT) and HIV care and treatment programs in a seamless continuum across the entire PMTCT cascade. We propose Mother Infant Retention for Health (MIR4Health), an innovative implementation science study focused on identifying an effective multicomponent strategy to improve linkage and retention of newly identified HIV infected pregnant women accessing mother child health services in Nyzana Province, Kenya. The study is a randomized trial to compare the effectiveness of a novel strategy using Active Patient Follow-Up (APFU) to engage and retain newly identified pregnant HIV-infected women and their infants in care compared to the current standard of care (SOC) for the retention of the women and their exposed infants postpartum. The proposed APFU includes a package of evidence-based interventions including health education, provision of phone and short message service appointment reminders, active tracking of patients for linkage and retention, and individualized retention and adherence support. The primary aim is to evaluate the effectiveness of APFU plus SOC compared to SOC on the combined outcome of retention of both mother and infant at 6 months postpartum. In addition, we will examine the effectiveness of the intervention on other critical outcomes including maternal attendance at 2nd antenatal visit; changes in CD4+ cell count and HIV RNA viral load; Polymerase Chain Reaction (PCR) testing of HIV-exposed infants at 6 weeks; and adherence by women and infant to prescribed antiretroviral regimens. MIR4Health is distinguished by several innovations including the recognition that the newly identified HIV-infected pregnant woman especially vulnerable to poor retention within PMTCT and that both mother and child must be retained in care to ensure optimal health outcomes. The use of a feasible, pragmatic approach that addresses known barriers, builds on evidence based interventions and is potential to be scaled-up if successful can contribute to Kenya's efforts towards elimination of new pediatric infections and to safeguard maternal health.