Adherence to HIV Treatment Postpartum: The Implications of Transitions Among Women Living with HIV in South Africa

项目总结 预防母婴传播(母婴传播)的努力降低了垂直感染率 然而，最佳抗逆转录病毒治疗(ART)的依从性仍然是一个困难的目标 伸展，尤其是产后。拟议的研究预计将有两方面的贡献：1)获得 了解有影响力的环境、人际、临床和个人层面的因素在 孕产期过渡的关键时刻及其对ART依从性的影响 帮助母亲产后坚持抗逆转录病毒治疗的生物行为干预。应聘者：我 我是一名社会心理学家，在美国的社会弱势群体中有艺术坚持的背景 各州。我正在申请为期五年的K01职业发展奖，以获得培训、指导和 在资源有限的情况下成为艾滋病毒携带者妇女孕产妇健康专家的研究经验 环境和一名能够获得R01资金的独立调查员。指导：我已经整理了一份 在南方艾滋病毒治疗和预防研究方面拥有丰富经验的杰出指导团队 集流行病学、定性方法和临床科学于一体的非洲。唐·奥拉里奥和马克博士 Lurie将担任联合小学导师，并带来国际艾滋病毒行为方面的补充专业知识 干预发展与传染病流行病学。除了我的两位主要导师，我的同事- 导师提供特定内容领域和方法方面的专业知识，总部设在美国和 南非(ZA)。我的共同导师团队包括：Susan CuUvin博士(在美国，临床管理 艾滋病毒、产科和妇科)，Landon Myer博士(ZA，围产期流行病学，产后ART 坚持)，阿比盖尔·哈里森博士(美国，纵向定性方法，性和生殖 和克里斯托弗·科尔文博士(以ZA为基础的定性方法，孕产妇和儿童健康)。培训：特定 围产期流行病学培训、纵向定性方法、基于理论的干预、跨文化 干预措施的发展和评估将通过强化的辅导培训、课程工作、 研讨会、定向读物和初级ZA研究。在我优秀的指导团队的指导下，这些 培训和研究经验将为我的独立调查员职业生涯奠定基础，成为开发领域的专家 艾滋病毒治疗和预防干预措施，以解决高影响、低资源环境下的孕产妇保健问题， 考虑到过渡的关键时刻，并改变影响健康行为的因素。研究： 建议项目的目标是(1)确定背景、人际、临床和个人层面的因素 孕产期关键过渡期对妇女HIV治疗依从性的影响； (2)评价基于过渡理论的生物行为干预对产后ART依从性的影响 使用小规模随机对照试验；(3)评估参与者的干预体验， 感知的有用性，并确定改进干预措施以供未来评估的方法

PROJECT SUMMARY Prevention of mother-to-child transmission (PMTCT) efforts have reduced the rates of vertical transmission to 2.7%, however, optimal antiretroviral therapy (ART) adherence remains a difficult goal to reach, particularly postpartum. The contribution of the proposed research is expected to be two-fold: 1) to gain an understanding of how influential contextual, interpersonal, clinic, and individual level factors change during key moments of transition during pregnancy and postpartum and influence ART adherence and 2) to develop bio-behavioral interventions to assist mothers in maintaining their adherence to ART postpartum. Candidate: I am a social psychologist with a background in ART adherence socially disadvantaged groups in the United States. I am applying for a five-year K01 Career Development Award to obtain training, mentorship, and research experience to become an expert in maternal health among women living with HIV in resource limited settings and an independent investigator capable of obtaining R01 funding. Mentoring: I have put together an exceptional mentoring team with extensive experience in HIV treatment and prevention research in South Africa that integrates epidemiology, qualitative methods, and clinical science. Drs. Don Operario and Mark Lurie will serve as co-Primary mentors and bring complementary expertise in international HIV behavioral intervention development and infectious disease epidemiology. In addition to my two Primary mentors, my co- mentors provide expertise in specific content areas and methodologies and are based in both the U.S. and South Africa (ZA). My co-mentorship team includes: Dr. Susan Cu-Uvin (U.S.-based, clinical management of HIV, obstetrics and gynecology), Dr. Landon Myer (ZA-based, perinatal epidemiology, postpartum ART adherence), Dr. Abigail Harrison (U.S.-based, longitudinal qualitative methods, sexual and reproductive health), and Dr. Christopher Colvin (ZA-based, qualitative methods, maternal child health). Training: Specific training in perinatal epidemiology, longitudinal qualitative methods, theory-based interventions, cross-cultural intervention development and evaluation will be achieved through intensive mentored training, coursework, workshops and directed readings and primary ZA research. Guided by my excellent mentorship team, these training and research experiences will establish my independent investigator career as an expert in developing HIV treatment and prevention interventions to address maternal health in high impact, low resource settings, that take into account key moments of transition and change that impact health behaviors. Research: The goals of the proposed project are to (1) identify contextual, interpersonal, clinic, and individual level factors that influence women's HIV treatment adherence during key period of transition during pregnancy and postpartum; (2) evaluate a Transition Theory-based bio-behavioral intervention to improve ART adherence postpartum using a small scale randomized controlled trial; (3) assess participants' experiences of the intervention, perceived usefulness, and identify ways to refine the intervention for future evaluation