Integrating HIV with Innovative Group Antenatal Care in Two African Countries

描述（由申请人提供）：减少新的艾滋病毒感染是全球卫生优先事项，特别是在撒哈拉以南非洲，70%的新的艾滋病毒感染和75%的垂直感染发生在那里。由于卫生工作者和其他资源短缺，在产前保健（ANC）对孕妇进行初步艾滋病毒检测以及将艾滋病毒阳性患者转介预防母婴传播（PMTCT）和治疗方面存在很大的覆盖差距。此外，ANC几乎没有注意到艾滋病毒阴性孕妇的预防需要。因此，研究人员和决策者呼吁采用创新的方法重新定义ANC- HIV-PMTCT护理连续性。拟议的R21将是在低资源、高艾滋病毒流行环境中首次采用中心妊娠（CP）组ANC护理模式。向集体护理的转变是一种创新模式，可以更有效地利用保健医生的时间，并通过将与艾滋病毒有关的基本信息和服务纳入面向所有妇女（无论其艾滋病毒状况如何）的非核心保健服务，提高护理质量。在cp -非洲，预产期相近的12名混合状态（艾滋病毒阳性和阴性）妇女在每次产前检查时都与同一名训练有素的医生会面。自我评估和从业人员评估以及从业人员发起的与其他服务（例如预防母婴传播）的联系发生在前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，从而改变行为和增加卫生系统的使用。随着妇女与特定的医生建立合作关系，护理的连续性将加强与艾滋病毒相关服务和其他服务的联系。通过邀请男性参加艾滋病毒会议，然后提供检测机会，促进夫妻检测。这台R21将用于完成必要的发展工作，使我们能够将这种改变范式的模式带到撒哈拉以南非洲，并使我们能够大规模地测试CP-Africa的功效。在社区参与性研究原则的指导下，我们将在马拉维和坦桑尼亚这两个艾滋病毒患病率（11% vs 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非洲合作伙伴计划。将与利益攸关方合作制定ANC会议和活动、安排执业时间、会议空间、组成小组和促进对个别妇女艾滋病毒、预防母婴传播和其他所需服务的后续行动的程序。对撒哈拉以南非洲来说，新的结果测量方法将通过认知访谈得到验证。然后，我们将在4个地点试验整个CP-非洲方案，192名妇女随机分为CP-非洲组或个体化护理组；获取基线、妊娠晚期和产后8周的结局数据；并对执行过程进行全程评价，包括直接观察会议和由妇女和提供者进行质量评价。这项研究的数据将被整理并用于完善cp -非洲一揽子计划，为临床试验做准备。如果非洲方案能够成功地在两个非洲国家进行调整，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.