Perinatal Depression, Stigma, Social Capital Utilization and PMTCT Adherence

说明(申请人提供)：联合国千年发展目标(千年发展目标)说明了全世界需要妇女和儿童生活的关键领域，包括改善产妇健康和降低儿童死亡率。能否成功实现这两个目标取决于降低艾滋病毒垂直传播率。撒哈拉以南非洲是千年发展目标所针对的地区之一，在很大程度上承受着艾滋病毒疾病的负担，截至2008年底，有2200多万艾滋病毒携带者，其中相当一部分是育龄妇女。抑郁症与不遵守一系列健康行为有关，这一系列健康行为被称为预防艾滋病毒母婴传播(PMTCT)。在资源有限的情况下，妇女在遵守防止母婴传播方面可能面临更多障碍，包括耻辱和结构性障碍。虽然依靠社区资源(称为社会资本)可以绕过结构性障碍，但抑郁和耻辱可能会使获得这些资源变得困难。因此，了解有助于遵守防止母婴传播的可修改因素的作用对于实现千年发展目标至关重要。应聘者：我是一名临床心理学家，最近转到麻省总医院/哈佛医学院任教。我正在申请为期五年的K23职业发展奖，以获得培训和指导，以便成为R01级别的独立调查员，以及在资源有限的情况下研究抑郁症和坚持对艾滋病毒感染妇女的健康至关重要的健康行为的专家。指导：我的主要导师(Safren)和合作导师(Bangsberg)都保护了我的时间，以便通过以患者为导向的研究中的K24职业中期调查员奖致力于我的指导。两人都是在国际环境下坚持抗逆转录病毒治疗领域的专家。萨夫伦博士是麻生太郎研究抑郁症和行为干预发展的专家。此外，我还组建了一个顾问小组，他们在我的建议的其他关键方面有专门知识，包括妇女生殖健康(SMIT)、防止母婴传播(Peltzer)、耻辱(Kalichman)、社会网络和健康(Christakis)和生物统计学(Ghebremichael)。研究：该项目的目标是：(1)调查围产期抑郁、耻辱、社会资本利用、母婴传播依从性之间的关系；(2)在资源有限的情况下，测试一项试点干预措施，以治疗围产期抑郁症并提高艾滋病毒感染妇女对抗逆转录病毒药物的依从性。培训：我的研究活动将得到与导师的有组织的会议的支持，以及哈佛公共卫生学院在发展中国家的先进统计方法、精神流行病学和医疗保健方面的课程作业，这些课程的时间安排将补充我提议的研究活动。我出色的指导团队、强有力的机构支持、创新的研究问题，以及我致力于解决与艾滋病毒感染妇女及其子女的健康相关的问题，使我处于有利地位，能够实现我成为一名独立调查员的目标。

DESCRIPTION (provided by applicant): The United Nations Millennium Development Goals (MDGs) illustrate key areas in which the lives of women and children worldwide are in need, including improving maternal health and a reduction in childhood mortality. The success of meeting both these goals depends on reducing rates of vertical transmission of HIV. Sub-Saharan Africa is one of the areas targeted by the MDGs and bears a substantial degree of HIV disease burden, with well over 22 million people living with HIV at the end of 2008, a significant number of whom are women of reproductive age. Depression has been associated with non-adherence to the series of health behaviors known as preventing mother-to-child transmission (PMTCT) of HIV. Women in resource limited settings are likely to face additional barriers to PMTCT adherence, including stigma and structural barriers. While structural barriers may be circumvented by relying on community resources (known as social capital), depression and stigma may make it difficult to access these resources. Thus, understanding the role of modifiable factors that contribute to PMTCT adherence is critical to meeting the goals of the MDGs. Candidate: I am a clinical psychologist and recently transitioned to faculty at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain training and mentorship in order to become an independent investigator at the R01 level, and an expert in depression and adherence to health behaviors important to the health of HIV infected women in resource limited settings. Mentoring: Both my primary mentor (Safren) and co-mentor (Bangsberg) have protected time to devote to my mentorship via K24 Mid-Career Investigator Awards in Patient-Oriented Research. Both are experts in the field of antiretroviral therapy adherence in international settings. Dr. Safren is aso an expert in depression and behavioral intervention development. In addition, I have assembled a team of consultants with expertise in other critical aspects of my proposal, including women's reproductive health (Smit), PMTCT (Peltzer), stigma (Kalichman), social networks and health (Christakis), and biostatistics (Ghebremichael). Research: The goals of the proposed project are to (1) investigate the relationships among perinatal depression, stigma, social capital utilization PMTCT adherence, and (2) to test a pilot intervention to treat perinatal depression and improve adherence to ARVs among HIV infected women in a resource limited setting. Training: My research activities will be supported by structured meetings with my mentors and coursework in advanced statistical methods, psychiatric epidemiology, and healthcare in developing countries at the Harvard School of Public Health, the timing of which will complement my proposed research activities. My exceptional mentoring team, strong institutional support, innovative research questions, and my commitment to addressing issues relevant to the health of HIV infected women and their children leave me well positioned to achieve my goal of becoming an independent investigator.