Postpartum HIV care engagement in the context of Option B+ in Tanzania

 描述（由申请人提供）：根据选项B+，即世界卫生组织建议并由坦桑尼亚采用的预防母婴传播（PMTCT）的新方法，所有感染艾滋病毒的孕妇在怀孕期间开始终身抗逆转录病毒治疗（ART），无论临床分期如何。该议定书为改善妇女的长期健康和预防传播带来了巨大希望，但人们对执行方面的挑战感到关切，特别是在妇女参与产后护理方面。在几个非洲环境中进行的纵向研究表明，妇女在产后期间退出艾滋病毒护理的风险很高。拟议研究的目标是审查备选方案B+在坦桑尼亚基利曼哈罗地区三个地点的执行情况，以了解设施和患者两级支持或阻碍妇女在分娩后参与艾滋病毒护理的因素，并确定支持成功执行备选方案B+的机会。这一目标将根据执行情况研究综合框架，通过三个目标和相关方法来实现。首先，我们将研究影响产后护理参与的设施水平因素。方法将包括临床观察，以了解实施过程，30个关键的知情人访谈，以探讨供应商的观点和经验，并审查512例患者的记录，以记录护理参与的结果。其次，我们将研究影响产后护理参与的患者层面因素。方法将包括一组100名艾滋病毒感染的妇女，在怀孕期间登记，并在产后3个月和6个月随访，以确定产后艾滋病毒护理参与的预测因素，并对24名妇女进行定性深入访谈，以提供进一步的数据背景。第三，我们将寻找机会改进方案B+的实施，以加强和促进产后艾滋病毒护理。方法将包括与提供者和患者的9个焦点小组讨论，以及一个利益相关者论坛，以分享和讨论研究结果。拟议的研究将解决支持妊娠期后妇女终身接受抗逆转录病毒治疗的迫切需要，因此支持方案B+方案的成功，以提高高感染、低资源环境中抗逆转录病毒治疗的覆盖率。通过多方法数据收集和利益相关者之间的三角测量，该研究有可能发现创新的实施解决方案，这些解决方案可以在多地点干预试验中进一步完善和测试。坦桑尼亚莫希的基利曼哈罗基督教医疗中心（KCMC）有能力领导关于这一主题的实施科学研究。NIH和PEPFAR对KCMC进行了战略投资，以发展其作为优秀研究中心的能力，包括来自五个NIH研究所的资金， 以及MEPI和AITRP能力建设奖。 这项研究将以这些投资为基础，进一步加强KCMC在坦桑尼亚开展有意义的实施科学研究的能力。

 DESCRIPTION (provided by applicant): Under Option B+, the new approach for prevention of mother to child transmission (PMTCT) recommended by the World Health Organization and adopted by Tanzania, all HIV-infected pregnant women begin lifetime antiretroviral therapy (ART) during pregnancy, regardless of clinical staging. This protocol holds great promise for improving women's long-term health and preventing forward transmission, but there are concerns about implementation challenges, particularly regarding women's engagement in care in the postpartum period. Longitudinal research in several African settings suggest that women are at high risk of HIV care drop- out in the postpartum period. The goal of the proposed study is to examine the implementation of Option B+ in three sites in the Kilimanjaro Region of Tanzania, to understand factors at both the facility and patient levels that support or obstruct women's engagement with HIV care following childbirth, and to identify opportunities to support the successful implementation of Option B+. This goal will be accomplished through three aims and related methods, based on the Consolidated Framework for Implementation Research. First, we will examine facility-level factors influencing postpartum care engagement. Methods will include clinical observations to understand process of implementation, 30 key informant interviews to explore provider perspectives and experiences, and review of 512 patient records to document care engagement outcomes. Second, we will examine patient-level factors influencing post-partum care engagement. Methods will include a cohort of 100 HIV-infected women, enrolled during pregnancy and followed at 3 and 6 months postpartum to identify predictors of postpartum HIV care engagement, and qualitative in-depth interviews with a subset of 24 women to provide further context to the data. Third, we will identify opportunities to improve implementation of Option B+ so that it enhances and promotes postpartum HIV care. Methods will include 9 focus group discussions with providers and patients, and a stakeholder forum to share and discuss the study findings. The proposed study will address the critical need to support engagement with lifelong ART for women beyond the pregnancy period, and therefore support the success of the Option B+ protocol for improving the coverage of ART in high- infection, low-resource settings. Through multi-methods data collection and triangulation across stakeholders, the study has the potential to uncover innovative implementation solutions, which can be further refined and tested in a multi-site intervention trial. Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania is well positioned to lead an implementation science study on this topic. The NIH and PEPFAR have made strategic investments at KCMC to develop its capacity as a research center of excellent, including funding from five NIH institutes, and MEPI and AITRP capacity-building awards. This study will build upon those investments to further strengthen KCMC's capacity to conduct meaningful implementation science research in Tanzania.