Developing a Two-way SMS Platform to Prevent and Treat Wasting Among HIV-infected and HIV-exposed Uninfected Children

项目摘要/摘要 25%的感染艾滋病毒的儿童有童年消瘦(身高比体重低或中上半身低)。 臂围和未感染艾滋病毒(HEU)的儿童体重不足的可能性是前者的两倍 类似的未接触艾滋病毒的儿童。众所周知，消瘦会增加发病率、艾滋病毒进展和死亡率。 在这些孩子中。改进对儿童和婴儿早期诊断和治疗的消瘦预防和治疗 艾滋病毒护理方案不仅可以改善这些儿童的儿童健康状况，而且还能大大改善这些儿童的健康状况。 降低全球儿童浪费的负担。 这项提议将开发一个新的双向短信服务(SMS)平台，针对以下关键障碍 改善对HEU和艾滋病毒感染儿童的营养护理。这一干预将从母性上结合起来 管理营养不良监测系统(MAMMS)与婴幼儿教育(IYCF)一起提供 通过短信。在使用参与式设计方法开发干预措施后，我们将完成 MAMMS-IYCF在R21上的概念准实验试验。如果达到了R21里程碑，我们将使用 R33进行随机试验，测试MAMMS-IYCF在减少发病率浪费方面的有效性， 以及浪费治疗的持续时间。在这次试验中，我们还将评估以下各项的成本和成本效益 MAMMS-IYCF，为了更好地了解哪些障碍正在通过干预成功解决，我们将 衡量其对关键态度和行为结果的影响，包括对医疗保健系统的信任、意图 寻找一个孩子是否变得虚弱，以及IYCF的知识。这场审判将产生必要的证据 将MAMMS-IYCF干预措施整合到全球现有的艾滋病毒-mHealth计划中，并改善 儿童在早期婴儿诊断和艾滋病毒护理服务中的结果，同时也大大降低了全球 童年浪费的负担。

PROJECT SUMMARY/ABSTRACT Twenty-five percent of children with HIV-infection have childhood wasting (low weight-for-height or low mid-upper arm circumference, and HIV-exposed uninfected (HEU) children are twice as likely to be underweight as comparable HIV-unexposed children. Wasting is known to promote morbidity, HIV-progression, and mortality among these children. Improving wasting prevention and treatment for children and in early infant diagnosis and HIV-care programs could not only improve the child health outcomes of these children, but also substantially lower the global burden of childhood wasting. This proposal will develop a novel two-way short message service (SMS) platform that targets key barriers to improving nutritional care for HEU and HIV-infected children. This intervention will combine a maternally administered malnutrition monitoring system (MAMMS) with infant and young child education (IYCF) delivered by SMS. After developing the intervention using participatory design methods, we will complete a proof-of- concept quasi-experimental trial of MAMMS-IYCF in the R21. If the R21 milestones are meet, we will use the R33 to conduct a randomized trial testing the effectiveness of MAMMS-IYCF at reduced the incidence wasting, and the duration of wasting treatment. During this trial we will also assess the cost and cost-effectiveness of MAMMS-IYCF, and to better understand which barriers are being successfully addressed by intervention we will measure its effect on key attitudinal and behavioral outcomes including trust in the healthcare system, intention to seek if a child becomes wasted, and IYCF knowledge. This trial will generate the evidence necessary to integrate MAMMS-IYCF interventions into existing HIV-mHealth programs across the globe, and improve the outcomes of children in early infant diagnosis and HIV-care services while also substantially lowering the global burden of childhood wasting.