Perinatal Depression, Stigma, Social Capital Utilization and PMTCT Adherence

说明（由申请人提供）：联合国千年发展目标说明了全世界妇女和儿童生活需要改善的关键领域，包括改善产妇保健和降低儿童死亡率。成功实现这两个目标取决于降低艾滋病毒垂直传播率。撒哈拉以南非洲是千年发展目标的目标地区之一，艾滋病毒疾病负担沉重，截至2008年底，该地区有2 200多万人感染艾滋病毒，其中很大一部分是育龄妇女。抑郁症与不遵守预防艾滋病毒母婴传播（PMTCT）的一系列健康行为有关。在资源有限的环境中，妇女在坚持预防母婴传播方面可能面临更多障碍，包括污名化和结构性障碍。虽然依靠社区资源（称为社会资本）可以规避结构性障碍，但抑郁和耻辱可能使获得这些资源变得困难。因此，了解有助于坚持预防母婴传播的可改变因素的作用对于实现千年发展目标至关重要。我是一名临床心理学家，最近刚转到麻省总医院/哈佛医学院任教。我正在申请一个为期五年的K23职业发展奖，以获得培训和指导，以便成为一名R01级别的独立调查员，以及在资源有限的环境中对艾滋病毒感染妇女健康重要的抑郁和坚持健康行为方面的专家。指导：我的主要导师（Safren）和共同导师（Bangsberg）都通过K24患者导向研究中期职业研究者奖来保护我的指导时间。两人都是国际环境中抗逆转录病毒治疗依从性领域的专家。萨夫伦博士也是抑郁症和行为干预发展方面的专家。此外，我还组建了一个顾问团队，他们在我的提案的其他关键方面具有专业知识，包括妇女生殖健康（Smit）、预防母婴传播（Peltzer）、耻辱（Kalichman）、社会网络和健康（Christakis）以及生物统计学（Ghebremichael）。研究：拟议项目的目标是：(1)调查围产期抑郁症、耻辱、社会资本利用与PMTCT依从性之间的关系；(2)在资源有限的环境下测试一项试点干预措施，以治疗围产期抑郁症并提高艾滋病毒感染妇女对抗逆转录病毒药物的依从性。培训：我的研究活动将通过与导师的结构化会议和哈佛公共卫生学院的高级统计方法、精神流行病学和发展中国家卫生保健课程来支持，这些课程的时间安排将补充我拟议的研究活动。我出色的指导团队、强有力的机构支持、创新的研究问题，以及我对解决与感染艾滋病毒的妇女及其子女的健康有关的问题的承诺，使我能够很好地实现成为一名独立研究者的目标。

DESCRIPTION (provided by applicant): The United Nations Millennium Development Goals (MDGs) illustrate key areas in which the lives of women and children worldwide are in need, including improving maternal health and a reduction in childhood mortality. The success of meeting both these goals depends on reducing rates of vertical transmission of HIV. Sub-Saharan Africa is one of the areas targeted by the MDGs and bears a substantial degree of HIV disease burden, with well over 22 million people living with HIV at the end of 2008, a significant number of whom are women of reproductive age. Depression has been associated with non-adherence to the series of health behaviors known as preventing mother-to-child transmission (PMTCT) of HIV. Women in resource limited settings are likely to face additional barriers to PMTCT adherence, including stigma and structural barriers. While structural barriers may be circumvented by relying on community resources (known as social capital), depression and stigma may make it difficult to access these resources. Thus, understanding the role of modifiable factors that contribute to PMTCT adherence is critical to meeting the goals of the MDGs. Candidate: I am a clinical psychologist and recently transitioned to faculty at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain training and mentorship in order to become an independent investigator at the R01 level, and an expert in depression and adherence to health behaviors important to the health of HIV infected women in resource limited settings. Mentoring: Both my primary mentor (Safren) and co-mentor (Bangsberg) have protected time to devote to my mentorship via K24 Mid-Career Investigator Awards in Patient-Oriented Research. Both are experts in the field of antiretroviral therapy adherence in international settings. Dr. Safren is aso an expert in depression and behavioral intervention development. In addition, I have assembled a team of consultants with expertise in other critical aspects of my proposal, including women's reproductive health (Smit), PMTCT (Peltzer), stigma (Kalichman), social networks and health (Christakis), and biostatistics (Ghebremichael). Research: The goals of the proposed project are to (1) investigate the relationships among perinatal depression, stigma, social capital utilization PMTCT adherence, and (2) to test a pilot intervention to treat perinatal depression and improve adherence to ARVs among HIV infected women in a resource limited setting. Training: My research activities will be supported by structured meetings with my mentors and coursework in advanced statistical methods, psychiatric epidemiology, and healthcare in developing countries at the Harvard School of Public Health, the timing of which will complement my proposed research activities. My exceptional mentoring team, strong institutional support, innovative research questions, and my commitment to addressing issues relevant to the health of HIV infected women and their children leave me well positioned to achieve my goal of becoming an independent investigator.