Perinatal depression and key care outcomes in pregnant Malawian women with HIV

项目摘要/摘要 针对艾滋病毒感染者的抗逆转录病毒治疗(ART)有效地减少了新的艾滋病毒感染。在子- 撒哈拉非洲，育龄妇女是抗逆转录病毒治疗的重要目标，以改善她们自己 并防止艾滋病毒传染给他们的性伴侣和婴儿。在马拉维，一个 在南部非洲，成年妇女的艾滋病毒流行率很高，为13%。马拉维是撒哈拉以南地区的第一个国家 非洲将采用“方案B+”，这是世界卫生组织的一项倡议，旨在启动和维持所有艾滋病毒感染者 孕妇终身接受抗逆转录病毒治疗，而不考虑CD4计数，这是抗逆转录病毒治疗资格标准的显著扩展。 备选方案B+有可能大幅减少艾滋病毒传播和妇女发病率和死亡率，但 只有妇女能够长期接受抗逆转录病毒治疗，并保持病毒抑制所需的高度依从性。 Option B+计划导致马拉维开始接受ART的女性人数急剧增加，但 在让妇女继续接受艾滋病毒护理、接受治疗和产后病毒抑制方面的努力还不够。 HIV护理中的保留、抗逆转录病毒治疗的依从性和病毒抑制受到潜在的可修改因素的影响 心理社会因素，包括围产期抑郁。抑郁症在艾滋病毒感染者中更为常见 而不是在普通人群中。虽然抑郁症被证明会对艾滋病毒的结局产生负面影响，但 在美国，还没有研究研究围产期抑郁对护理和病毒感染的影响 在非洲对感染艾滋病毒的孕妇进行抑制。 这项Kirschstein-NRSA个人奖学金(F30)提案的总体目标是确定 围产期抑郁对两个关键的艾滋病毒护理结果的影响-保留护理和病毒抑制 -在马拉维感染艾滋病毒的孕妇中。结果将确定 在不断增长的B+选择人群中出现围产期抑郁，并为未来有关心理健康的政策决策提供信息 在马拉维和可能的其他备选方案B+撒哈拉以南非洲国家为感染艾滋病毒的妇女提供保健。 这项建议的具体目的是：1)估计围产期抑郁症的患病率和发病率； 2)确定产后抑郁的预测因素；以及3)估计围产期抑郁与 抑郁症与护理和病毒抑制的保留。建议的研究嵌套在 正在进行的纵向队列研究旨在检查选项B+的长期安全性和有效性 在马拉维的项目。 通过这项研究项目和精心设计的培训计划，学员将实现以下目标 奖学金目标：1)发展以人群为基础的研究设计、数据收集、分析和 交流结果；2)掌握临床和转化性研究的技能，以促进临床研究的整合 和研究追求；以及3)发展专业技能，以促进成功的学术生涯。

Project summary/Abstract Antiretroviral treatment (ART) for HIV-infected persons is effective at reducing new HIV infections. In sub- Saharan Africa, women of reproductive age are an important target for ART in order to improve their own health as well as to prevent HIV transmission to their sexual partners and their infants. In Malawi, a country in southern Africa, HIV prevalence in adult women is high at 13%. Malawi was the first country in sub-Saharan Africa to adopt “Option B+,” a World Health Organization initiative to start and maintain all HIV-infected pregnant women on lifelong ART regardless of CD4 count, a significant expansion in ART eligibility criteria. Option B+ has the potential to substantially reduce HIV transmission and women's morbidity and mortality, but only if women can be retained on ART long-term with the high adherence required to sustain viral suppression. The Option B+ program has led to a dramatic increase in the number of women starting ART in Malawi, but efforts at keeping women in HIV care, on treatment, and virally suppressed post-delivery have fallen short. Retention in HIV care, ART adherence, and viral suppression are influenced by potentially modifiable psychosocial factors, including perinatal depression. Depression is more common among HIV-infected persons than among the general population. While depression has been shown to negatively impact HIV outcomes in the United States, no studies have examined the impact of perinatal depression on retention in care and viral suppression among HIV-infected pregnant women in Africa. The overall objective of this Kirschstein-NRSA individual fellowship (F30) proposal is to identify the influence perinatal depression on two key HIV care outcomes – retention in care and viral suppression – among HIV-infected pregnant women in Malawi. The results will establish the burden and timing of perinatal depression in the growing Option B+ population and inform future policy decisions regarding mental health care for HIV-infected women in Malawi and possibly other Option B+ sub-Saharan African countries. The specific aims of this proposal are: 1) Estimate the prevalence and incidence of perinatal depression; 2) Identify predictors of incident postpartum depression; and 3) Estimate the association of perinatal depression with retention in care and viral suppression. The proposed research is nested within an ongoing longitudinal cohort study designed to examine the long-term safety and efficacy of the Option B+ program in Malawi. Through this research project and a carefully constructed training plan, the trainee will achieve the following fellowship goals: 1) develop advanced skills in population-based study design, data collection, analysis, and communication of results; 2) acquire skills in clinical and translational research to facilitate integration of clinical and research pursuits; and 3) develop professional skills that will facilitate a successful academic career.