Behavioral Health Determinants of Adherence in Women Living with HIV

项目总结 抗逆转录病毒疗法(ART)的坚持和保留在护理中至关重要，但人们对此知之甚少。 美国艾滋病毒携带者妇女护理面临的挑战。产后磨损与非ART 坚持让艾滋病毒携带者面临免疫妥协和免疫系统损害的危及生命的医疗并发症 计划外和未经医学优化的怀孕具有更大的母婴传播风险。这个 这项建议的长期目标是改善对艾滋病毒携带者妇女护理的遵守和保留。 为了实现这一目标，我们建议对怀孕和怀孕期间感染艾滋病毒的妇女进行前瞻性队列研究。 产后1)在每三个月和产后采用客观的ART依从性措施，2) 描述产后对ART的依从性和保留性的行为健康预测因素，以及3) 告知未来行为健康干预研究的可行性和设计，以提高依从性 以及留守在看护中心。我们提案的目标与国家精神卫生研究所艾滋病部门的目标相符 研究重点“，以开发和测试改善艾滋病毒治疗结果的干预措施 通过最佳的治疗坚持和持续的护理参与“。我们的具体目标是：1：适应 并在妊娠和产后各三个月应用TDF粘附仪，检测 假设依从性浓度基准在怀孕第二和第三个三个月时较低 产后立即恢复正常，产后恢复正常。2：检验与创伤相关的假设 行为健康指标通过以下方式预测产后依从性和保留率 在怀孕期间实施一系列行为健康措施(抑郁、创伤后应激障碍、焦虑) 研究产后依从性和保留率之间的关系。 我的长期职业目标是建立一个跨学科的独立研究生涯，专注于 改善孕期及以后感染艾滋病毒的妇女的医疗保健和临床结果。这个 赠款的培训方面将侧重于教学课程工作和体验式学习的结合，以 实现我的职业发展目标：具备1)药理学方面的专业知识，即药代动力学研究 和数据分析，以及2)行为健康，特别是与创伤、艾滋病毒和 妊娠/产后，以及3)实施临床和行为健康随机对照试验。 由中大共同提供的学术环境、机构支持和特殊资源- 大西洋CFAR财团、MedStar Health和约翰霍普金斯大学为 作为一名调查员的成长。这一综合、全面的研究经验与 密集的指导、授课和参与学习者社区将直接推动我的 职业发展目标，并为我提供必要的工具和经验来过渡到 成功、跨学科、独立的临床研究人员。

PROJECT SUMMARY Antiretroviral therapy (ART) adherence and retention in care are critically important and poorly understood challenges in the care of women living with HIV in the United States. Postpartum attrition and ART non- adherence leave women with HIV at risk for life-threatening medical complications of immunocompromise and unplanned and not-medically-optimized pregnancies with greater risk of mother-to-child transmission. The long-term objective of this proposal is to improve adherence and retention in care for women living with HIV. To achieve this objective, we propose a prospective, cohort study of women with HIV during pregnancy and postpartum to 1) adapt an objective ART adherence measure in each trimester and postpartum, 2) characterize the behavioral health predictors of postpartum ART adherence and retention in care, and 3) inform the feasibility and design of future research on behavioral health interventions to improve adherence and retention in care. Our proposal's goals match the National Institute of Mental Health Division of AIDS Research high research priority “to develop and test interventions to improve HIV treatment outcomes through optimal treatment adherence and sustained engagement in care”. Our specific aims are to: 1: Adapt and apply the TDF adherence instrument in each trimester of pregnancy and postpartum and test the hypothesis that adherence concentration benchmarks will be lower in the 2nd and 3rd trimesters of pregnancy and immediately postpartum, normalizing in the postpartum period. 2: Test the hypothesis that trauma-related behavioral health indicators are predictive of postpartum adherence and retention in care, through administration of a battery of behavioral health measures (depression, PTSD, anxiety) during pregnancy and examining associations with postpartum adherence and retention in care. My long-term career goal is to establish an interdisciplinary independent research career focused on improving the medical care and clinical outcomes of women living with HIV during pregnancy and beyond. The training aspect of the grant will focus on a combination of didactic course work and experiential learning to achieve my career development objectives: expertise in 1) pharmacology, namely pharmacokinetic research and data analysis, and 2) behavioral health, specifically mental health topics pertaining to trauma, HIV and pregnancy/postpartum, and 3) implementation of clinical and behavioral health randomized controlled trials. The academic environment, institutional support, and exceptional resources collectively provided by the Mid- Atlantic CFAR consortium, MedStar Health, and Johns Hopkins University provide an ideal opportunity for growth as an investigator. This integrated, comprehensive combination of research experience combined with intensive mentoring, didactic coursework, and participation in a community of learners will directly advance my career development objectives and provide me with the necessary tools and experience to transition to a successful, interdisciplinary, independent clinical researcher.