Integrating HIV and Depression Self Care to Improve Adherence in Perinatal Women

描述(由申请人提供)：低资源国家的妇女感染艾滋病毒和围产期抑郁症的风险很高，但由于各种个人、实际和组织方面的限制，她们获得心理健康和艾滋病毒治疗服务的可能性最小。单独而言，艾滋病毒和围产期抑郁症使妇女及其子女面临健康状况不佳的风险；这些共病共同作用，加剧了风险，对孕产妇、儿童和公共卫生结果产生了严重后果。拟议的研究将通过评估一种创新干预方法--BEST-MACARE[更好的教育、支持、产妇能力治疗、坚持、留住照料]的可行性和初步效果，直接处理这一重要但被忽视的领域。这种多组成部分的干预措施被整合到常规的围产期护理中，并使用辅助手机咨询，这是一种有希望的可持续方式，可以接触到患有共同疾病的妇女并使其参与护理，并改善健康结果。在资源有限的情况下测试的大多数手机干预都依赖于短信。电话咨询似乎更适合于解决女性在资源有限的环境中面临的健康挑战，因为许多女性在识字和语言方面存在障碍，即使是简单的短信也难以破译。在美国，干预方法被发现在改善艾滋病毒携带者的依从性和自我护理行为方面有效，但它在解决不同社会文化、有限资源环境中患有共同疾病的妇女在护理方面的显著差距方面的有效性尚未得到检验。该项目将使用一个基于证据、节省时间和资源的程序(ADAPT-ITT)来修改干预措施，以便在与最初创建的不同的社会文化环境中实施。这项研究将在印度班加罗尔进行，为期两年，考虑到女性抑郁症和艾滋病毒的高发病率，农村和城市地区移动电话的广泛使用，以及多学科团队适合两国互补的专业知识，这是一个理想的环境。在第一年，我们在班加罗尔的产前公共诊所对患者和提供者(n=35)进行了启发性研究，以加深我们对处于社会文化约束角色和干预杠杆的妇女的风险动态的理解。在项目的第二年，我们将按照Ib阶段试验的目标，进行可行性测试和初步探索干预的效果，为全面的疗效试验(R01)做准备。我们将采用两个上午的随机组间实验设计(Best-Macare与注意力控制条件)，并在24周内的5个时间点检查临床结果和过程变量的标准化、重复相关测量。

DESCRIPTION (provided by applicant): Women in low-resource countries are at high risk for co-morbid HIV and perinatal depression, yet are the least likely to obtain mental health and HIV treatment services because of a variety of personal, practical and organizational constraints. Independently, HIV and perinatal depression place women and their children at risk for poor health outcomes; together, these co-morbidities interact to compound the risk, having serious consequences for maternal, child, and public health outcomes. The proposed study will directly address this important, but neglected area by evaluating the feasibility and preliminary efficacy of an innovative intervention approach, BEST-maCARE [Better Education, Support, Treatment for maternal Capacity, Adherence, REtention in care]. The multi-component intervention is integrated into routine perinatal care and uses adjunctive mobile phone counseling, a promising, sustainable way to reach and engage women with co-morbid conditions in care and improve health outcomes. Most mobile phone interventions tested in limited-resource settings have relied on SMS text messaging. A phone counseling approach appears to be a more suitable for addressing the health challenges faced by women in resource-limited settings because many women have difficulties deciphering even simple text messages given literacy and language barriers. The intervention approach has been found effective in improving adherence and self-care behavior of persons living with HIV in the U.S., but its usefulness in addressing significant gaps in care among women with co-morbid conditions in a different socio-cultural, limited resource setting has not been examined. This project will use an evidence- based, time and resource-efficient process (ADAPT-ITT) to modify the intervention for delivery in different socio-cultural setting than originally created. The study will be conducted over two years in Bangalore, India, an ideal setting given high rates of depression and HIV among women, wide spread use of mobile phones in rural and urban areas, and fitting bi-national, complementary expertise of the multi-disciplinary team. During the first year we conduct elicitation research with patients and providers (n=35) in antenatal public clinics in Bangalore to deepen our understanding of the understanding of dynamics of risk among women embedded in socio-culturally constrained roles and leverage points for intervention. During the second year of the project, in accordance with the aims of a Stage Ib pilot trial, we will conduct test the feasibility and explore preliminay effect of the intervention to prepare for a full scale efficacy trial (R01). We will employ a two-am randomized between-groups experimental design (Best-maCare versus an attention control condition) and examine standardized, repeated dependent measures of clinical outcomes and process variables at 5 time points over 24-weeks.