Facilitating HCV Treatment through Tailored Prenatal Care for HCV Infected, Substance using Pregnant Women

 描述（由申请人提供）：丙型肝炎病毒（HCV）感染在不断增长的阿片类药物依赖（OD）孕妇人群中普遍存在。在过去十年中，怀孕期间使用非法药物，特别是使用阿片类药物的情况急剧增加，从每1，000名住院分娩1.19人增加到5.77人。由于静脉注射阿片类药物的使用率很高，40-75%的OD孕妇感染了HCV，超过28%的孕妇在怀孕期间被新诊断为HCV。怀孕和产后期间提供了独特的机会，以确定，教育和参与丙型肝炎病毒感染，物质使用孕妇。然而，许多HCV感染的孕妇没有得到适当的产前护理，不到2%的孕妇在分娩后一年内开始接受HCV治疗。在这个R21应用程序中，我们建议定性评估3个关键利益相关者群体（HCV感染的OD患者，产前护理提供者和肝病学家）的观点，这些利益相关者群体参与向HCV感染的OD孕妇和产后妇女提供医疗保健服务，以确定如何改善妊娠期间的HCV教育和评估，并促进分娩后的HCV治疗。具体目标是：1）对HCV感染的OD孕妇和产后患者进行单独的半结构化访谈，以了解患者对妊娠期间HCV感染以及产后治疗的障碍和促进因素的看法; 2）对产前护理提供者和肝病学家进行单独的半结构化访谈，以描述提供者对HCV感染的OD患者的最佳产前和产后护理交付的看法。定性方法和利益攸关方的参与已成为研究过程的核心组成部分，以提高干预措施的效率和有效性。该R21项目的总体目标是了解导致HCV感染妇女产前护理欠佳的因素，并确定改善妊娠期间HCV教育和评估的方法。该提案的定性结果将（a）提供对促进产前和专科护理提供者之间的提供者间对话和护理协调的策略的深入了解，（B）确定使怀孕患者参与改善HCV相关健康行为并鼓励产后治疗所需的内容和信息，以及（c）告知设计一种针对HCV感染患者的创新产前护理干预措施，该干预措施将在随后的R 01申请中进行测试，以确定一年后的HCV治疗率交付.我们的研究的广泛假设是，提高患者和提供者的HCV知识和意识将最大限度地提高HCV识别和患者在怀孕期间的参与，并促进HCV感染，物质使用妇女的产后治疗，从而改善两代人的长期健康。

 DESCRIPTION (provided by applicant): Hepatitis C virus (HCV) infection is prevalent among a growing population of opioid dependent (OD) pregnant women. Illicit drug use and specifically, opioid use during pregnancy has increased dramatically over the last decade from 1.19 to 5.77 per 1,000 hospital births. Due to high rates of intravenous opioid use, 40-75% of OD pregnant women are infected with HCV and over 28% are newly diagnosed with HCV during pregnancy. Pregnancy and the postpartum period offer unique opportunities to identify, educate and engage HCV infected, substance using pregnant women. However, many HCV infected pregnant patients do not receive appropriate prenatal care and less than 2% initiate HCV treatment within one year following delivery. In this R21 application, we propose to qualitatively evaluate the perspectives of 3 key stakeholder groups (HCV infected OD patients, prenatal care providers and hepatologists) involved in the delivery of health care services to HCV infected OD pregnant and postpartum women to identify ways to improve HCV education and evaluation during pregnancy and facilitate HCV treatment after delivery. The specific aims are: 1) Conduct individual semi- structured interviews with HCV infected OD pregnant and postpartum patients to understand the perspectives of patients regarding HCV infection during pregnancy and barriers and facilitators to postpartum treatment; 2) Conduct individual semi-structured interviews with prenatal care providers and hepatologists to describe the perspectives of providers regarding optimal prenatal and postpartum care delivery for HCV infected OD patients. Qualitative approaches and stakeholder engagement have become a central component of the research process in an effort to improve not only the efficacy, but the effectiveness of interventions. The overall goal of this R21 project is to understand the factors that contribute to suboptimal prenatal care for women with HCV and identify ways to improve HCV education and evaluation during pregnancy. The qualitative findings from this proposal will (a) offer insight into strategies to foster inter-provider dialogue and care coordination among prenatal and specialist care providers, (b) identify content and messaging necessary to engage pregnant patients in improved HCV-related health behavior and encourage postpartum treatment, and (c) inform the design an innovative prenatal care intervention for patients with HCV infection which will be tested in a subsequent R01 application on rates of HCV treatment one year after delivery. The broad hypothesis of our study is that improving patient and provider HCV knowledge and awareness will maximize HCV identification and patient engagement during pregnancy and facilitate postpartum treatment for HCV infected, substance using women thereby improving the long-term health of two generations.