Mechanisms and pilot intervention for addressing intimate partner violence and HIV in antenatal care

摘要 这份向国家精神卫生研究院提出的申请将为阿比盖尔·哈彻博士提供五年的K01 支持进一步的培训和有指导的研究。哈彻博士是诺斯大学的社会科学家。 卡罗莱纳(北卡罗来纳州)，具有研究艾滋病毒相关健康的社会驱动因素的经验。她曾在南非生活过 自2005年以来，她为围绕艾滋病毒的行为和社会研究奠定了坚实的职业基础 和产妇健康。K01奖将为关键的 职业生涯过渡，在此期间，哈彻博士将在国外相当长时间后返回教堂山，成为 独立调查者，北卡罗来纳大学健康行为部全球健康研究的组成部分。 预防母婴传播(PMTCT)方案只有在妇女服用药物的情况下才有效 然而，撒哈拉以南非洲的许多围产期妇女通常都有超高的依从性。亲密伴侣 暴力(IPV)恶化了妇女坚持抗逆转录病毒治疗(ART)的能力，并导致更高的 抑郁症。哈彻博士提出了三个目标，每个目标都与一个强有力的职业发展计划相关联 具备分析、适应和实施科学技能。首先，她将领导二次纵向分析 队列数据，以确定将IPV与艾滋病毒相关健康结局(ART依从性、病毒血症)联系起来的机制； 探索一条假想的心理健康之路。统计学和流行病学方面的课程和辅导 (Levin、Turan、B和Myer博士)将支持她的分析。第二，对围产期妇女的定性研究 卫生工作者将探索已确定的途径和干预想法。哈彻博士将系统地 采用基于证据的心理健康计划，通过对马拉维和赞比亚的实地访问和导师指导而得到加强 来自IPV和精神健康专家(Maman博士、Christofides博士和Pence博士)。第三，她将进行一次 评估干预内容、措施和研究条件可接受性的可行性研究。在准- 实验设计，她将指定约翰内斯堡市中心的两家诊所进行干预或提高标准 护理条件。在未来队列中跟踪80名女性将允许初步评估 对关键途径(围产期抑郁和IPV)的干预效果和艾滋病毒措施的改进(ART 坚持使用头发样本中的药物水平)。可行性研究将以以下课程为基础： 实施研究、研究设计和实施中专家的密集监督实践 防止母婴传播的科学(杜兰博士、J博士、布拉姆哈特博士和池博士)。总体而言，研究将提供初步结果 为未来试验的设计提供信息，以测试优化的业余卫生工作者策略。通过支持说教和 基于现场的学习和受保护的研究时间，K01将推动哈彻博士的职业发展 一位独立的艾滋病毒行为科学家，为艾滋病毒阳性妇女带来更好的健康和福祉。

ABSTRACT This application to the National Institutes of Mental Health will provide Dr. Abigail Hatcher with five years K01 support for further training and mentored research. Dr. Hatcher is a social scientist at the University of North Carolina (UNC) with experience studying social drivers of HIV-related health. She has lived in South Africa since 2005, where she has established a solid career foundation for behavioral and social research around HIV and maternal health. The K01 award will provide essential training and professional scaffolding for a critical career transition, during which Dr. Hatcher will return to Chapel Hill after considerable time abroad to be an independent investigator and integral part of UNC Department of Health Behavior's global health research. Prevention of mother-to-child transmission (PMTCT) programs are only effective if women take medication regularly, yet many perinatal women in sub-Saharan Africa have sup-optimal adherence. Intimate partner violence (IPV) worsens women's ability to adhere to antiretroviral therapy (ART), and leads to higher rates of depression. Dr. Hatcher proposes 3 aims, each linked to a robust career development plan advancing analytical, adaptation, and implementation science skills. First, she will lead secondary analysis of longitudinal cohort data to determine mechanisms linking IPV to HIV-related health outcomes (ART adherence, viremia), exploring a hypothesized pathway of mental health. Coursework and mentorship in statistics and epidemiology (Drs. Levin, Turan, B, and Myer) will support her analyses. Second, qualitative research with perinatal women and health workers will explore identified pathways and intervention ideas. Dr. Hatcher will systematically adapt evidence-based mental health programs, enhanced by site visits to Malawi and Zambia, and mentorship from IPV and mental health experts (Drs. Maman, Christofides, and Pence). Third, she will conduct a feasibility study to assess acceptability of intervention content, measures, and study conditions. In a quasi- experimental design, she will assign 2 inner-city Johannesburg clinics to intervention or enhanced standard of care conditions. Following 80 women in a prospective cohort will allow for preliminarily assessment of intervention effects on key pathways (perinatal depression and IPV) and refinement of HIV measures (ART adherence using drug levels in hair samples). The feasibility study will be underpinned by coursework in implementation research study design and intensive supervised practice from experts in implementation science for PMTCT (Drs. Turan, J, Brahmbhatt, and Chi). Overall, the research will provide preliminary results to inform design of a future trial testing an optimized lay health worker strategy. By supporting didactic and field-based learning and protected time for research, a K01 will advance Dr. Hatcher's career progression as an independent HIV behavioral scientist, leading to better health and wellbeing among HIV-positive women.