Integrating HIV with Innovative Group Antenatal Care in Two African Countries

说明(申请人提供)：减少新的艾滋病毒感染是一项全球卫生优先事项，特别是在撒哈拉以南非洲，那里发生了70%的新艾滋病毒感染和75%的垂直感染。由于卫生工作者和其他资源短缺，在产前护理(ANC)对孕妇进行初步艾滋病毒检测以及转介艾滋病毒阳性者以预防母婴传播(母婴传播)和治疗方面存在重大覆盖面缺口。此外，非国大几乎没有注意到艾滋病毒阴性孕妇的预防需求。因此，研究人员和政策制定者呼吁采用创新的方法来重新定义非国大-艾滋病毒-母婴传播连续护理的概念。拟议的R21将是中心妊娠(CP)组ANC护理模式在低资源、高艾滋病毒流行率环境下的第一次改编。向团体护理的转变是一种创新的模式，通过将与艾滋病毒有关的基本信息和服务纳入ANC，为所有妇女提供基本的艾滋病毒相关信息和服务，而不考虑艾滋病毒状况，从而更有效地利用卫生从业者的时间，并提高护理质量。在CP-Africa，12名具有相似预产期的混合身份(艾滋病毒阳性和阴性)妇女在每次非国大就诊时会见同一名训练有素的从业者。自我和从业者评估以及从业者发起的与其他服务的联系(例如，防止母婴传播)发生在前30分钟。随后是90分钟的教育和技能建设，以提高对艾滋病毒检测、预防和治疗方案的认识，并建立自我效能，从而改变行为并增加卫生系统的使用。持续的护理将加强与艾滋病毒相关服务和其他服务的联系，因为妇女与特定的从业人员建立了合作关系。夫妻检测的促进方式是邀请男性参加艾滋病毒会议，然后是检测机会。R21将被用来完成基本的开发工作，使我们能够将这种改变范式的模式带到撒哈拉以南非洲，并使我们能够走向大规模测试CP-Africa的有效性。在以社区为基础的参与性研究原则指导下，我们将在马拉维和坦桑尼亚、艾滋病毒感染率(11%比6%)、艾滋病毒检测率和预防母婴传播覆盖率不同的国家开发和试点CP-Africa。将与利益攸关方合作制定非国大会议和活动、安排从业人员时间、会议空间、组建小组和促进对个别妇女的艾滋病毒、防止母婴传播和其他所需服务的后续行动的程序。撒哈拉以南非洲新的成果衡量标准将通过认知访谈进行验证。然后，我们将在4个地点试点整个CP-Africa一揽子计划，192名妇女随机进入CP-Africa或个性化护理；获得基线、孕晚期和出生后8周的结局数据；并对实施过程进行全过程评估，包括由妇女和提供者直接观察会议和进行定性评估。这项研究的数据将被整理并用于完善CP-Africa一揽子计划，为临床试验做准备。如果CP-Africa能够在两个非洲国家成功地适应，这将增加在其他低资源环境中取得成功的可能性。

DESCRIPTION (provided by applicant): Reducing new HIV infections is a global health priority, especially in sub-Saharan Africa, where 70% of new HIV infections and 75% of vertical infections occur. Due to shortages in health workers and other resources, significant coverage gaps exist in initial HIV testing of pregnant women at antenatal care (ANC) and referrals of those who are HIV-positive for prevention of mother-to-child transmission (PMTCT) and treatment. Furthermore, almost no attention is given to the prevention needs of HIV-negative pregnant women at ANC. As a result, researchers and policy makers have called for innovative approaches to reconceptualize the ANC- HIV-PMTCT care continuums. The proposed R21 will be the first adaptation of the CenteringPregnancy (CP) group ANC care model in low-resource, high HIV prevalence settings. The shift to group care is an innovative paradigm that makes more efficient use of scare health practitioner time and improves quality of care by incorporating essential HIV-related information and services into ANC for all women, regardless of HIV status. In CP-Africa, a group of 12 mixed status (HIV positive and negative) women with similar due dates meet with the same trained practitioner at every ANC visit. Self and practitioner assessments and practitioner-initiated linkages to others services (e.g., PMTCT) occur in the first 30 minutes. This is followed by 90 minutes of education and skill-building to promote awareness of HIV testing, prevention, and treatment options and build self-efficacy leading to behavioral changes and increased health system use. Continuity of care will strengthen linkages to HIV-related and other services as women forge a collaborative relationship with a specific practitioner. Couples testing is promoted by inviting men to an HIV session followed by a testing opportunity. This R21 will be used to complete essential developmental work that will enable us to bring this paradigm- changing model to sub-Saharan Africa and allow us to move toward testing the efficacy of CP-Africa on a large scale. Guided by principles of community-based participatory research, we will develop and pilot CP-Africa in Malawi and Tanzania, countries with different HIV prevalence (11% vs. 6%), HIV testing rates, and PMTCT coverage. ANC sessions and activities, procedures to schedule practitioner time, meeting space, form groups and facilitate follow-up on individual women's HIV, PMTCT, and other needed services will be developed collaboratively with stakeholders. Outcome measures new to sub-Saharan Africa will be validated by cognitive interviewing. We will then pilot the entire CP-Africa package at 4 sites with 192 women randomized into CP- Africa or individualized care; obtain baseline, late pregnancy and 8 week post birth outcome data; and conduct full process evaluations of the implementation process including direct observation of sessions and qualitative assessments by women and providers. Data from this study will be collated and used to refine the CP-Africa package to prepare for a clinical trial. If CP-Africa can be successfully adapted in two African countries, this will enhance the likelihood of success in other low-resource settings.