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

描述（由申请人提供）：低资源国家的妇女患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，她们最不可能获得心理健康和艾滋病毒治疗服务。艾滋病毒和围产期抑郁症分别使妇女及其子女面临健康状况不佳的风险;这些合并症相互作用，加剧了风险，对孕产妇、儿童和公共健康产生严重后果。拟议的研究将直接解决这一重要但被忽视的领域，通过评估创新干预方法的可行性和初步疗效，BEST-maCARE [更好的教育，支持，治疗孕产妇能力，坚持，保留护理]。多成分干预措施被纳入常规围产期护理，并使用连续性移动的电话咨询，这是一种有前途的可持续方式，可以接触到患有合并症的妇女并使其参与护理，改善健康结果。在资源有限的环境中测试的大多数移动的电话干预都依赖于短信。电话咨询方法似乎更适合于解决妇女在资源有限的环境中面临的健康挑战，因为许多妇女由于识字和语言障碍，甚至很难破译简单的短信。在美国，这种干预方法被发现能有效地改善艾滋病毒感染者的依从性和自我护理行为，但是，对于在不同的社会文化和有限的资源环境中解决患有共病的妇女在护理方面的重大差距，这一做法是否有用，尚未得到审查。本项目将使用基于证据的、时间和资源效率高的过程（ADAPT-ITT）来修改干预措施，以便在不同于最初创建的社会文化环境中实施。这项研究将在印度的班加罗尔进行两年多，这是一个理想的环境，因为妇女中抑郁症和艾滋病毒的发病率很高，移动的电话在农村和城市地区的广泛使用，以及多学科团队的两国互补专业知识。在第一年，我们进行了启发式研究，患者和供应商（n=35）在产前公共诊所在班加罗尔，以加深我们的理解，了解妇女的风险动态嵌入在社会文化约束的角色和杠杆干预点。在计划的第二年，我们会按照第I B阶段先导试验的目的，进行可行性测试及研究干预措施的短期效果，为全面的成效试验（R 01）作好准备。我们将采用两上午随机组间实验设计（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局和过程变量的标准化，重复依赖性测量。

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.