Integration of a collaborative care model for mental health services into HIV care for pregnant and postpartum women in Kenya (the Tunawiri Study)

常见的精神障碍（CMD）抑郁症和焦虑症在肯尼亚人中很普遍，而且大部分都没有得到治疗。 怀孕和产后感染艾滋病毒的妇女。CMD导致孕产妇和儿童健康结果不佳 并导致PPWH中缺乏HIV护理参与和病毒学失败。虽然有效的治疗 CMD存在，在低收入和中等收入（LMIC）环境中的常规卫生保健中扩大治疗将需要 利益攸关方的参与以及有效性和执行数据，为扩大规模和可持续性提供信息。 我们的团队已经将其他有效的干预措施整合到肯尼亚的产前（ANC）和艾滋病毒护理中。我们现在 建议使用协作护理模式整合经过验证的心理健康服务，并结合低 加强循证干预（解决问题的治疗），同时针对已知的社会决定因素， PPWH的艾滋病毒相关健康（耻辱和IPV）。以目前艾滋病毒护理的多学科方法为基础 在肯尼亚，我们提出的合作护理模式（CCM）将利用现有的同伴指导母亲、非专家 行为护理经理和精神科护士;并将把一名顾问精神病学家纳入 ANC/艾滋病毒护理小组。在EPIS（探索-准备-实施-维持）框架的指导下， 总体研究目标是将围产期CMD的协作护理纳入常规ANC/HIV服务， 肯尼亚，评估这一方法的成本和成本效益，并与政策制定者和决策者合作， 确定扩大规模的关键考虑因素。具体而言，在目标1中，我们将确定背景障碍， 促进者，以完善最佳的整合模式，提供协作护理模式，使用多个， 方法数据收集（与供应商的焦点小组，与关键知情人的深入访谈，以及诊所 准备清单）。与我们的咨询委员会举行了一次讲习班，咨询委员会由县和国家一级的利益攸关方组成， 将使我们能够将调查结果转化为当地相关的CCM。在目标2中，我们将测试CCM PPWH 健康 期间 抑郁 保留目标3，我们将 通过成本效益和传播研究，完善《集束弹药公约》执行战略。我们将 进行成本计算和成本效益分析，并邀请政策制定者和决策者参加一个名义上的 小组技术进程，以阐明进一步扩大和维持集束弹药办法的因素。结果 这项研究将开发一个可扩展的模型，适用于其他LMIC环境，有助于全球艾滋病毒和 孕产妇健康目标，同时解决未经治疗的CMD的负担。 在产前护理方面， 在混合型2实施有效性试验中，在15个初级 肯尼亚西南部的医疗设施。我们将为诊断为CMD的PPWH引入CCM护理 产前护理。产后12个月的共同主要健康结局将是（1）从 或焦虑症状，以及（2）持续病毒抑制的PPWH比例， 艾滋病护理。关键的实施成果是可行性和可接受性。最后在

Common mental disorders (CMD) of depression and anxiety are prevalent and largely untreated among Kenyan pregnant and postpartum women living with HIV (PPWH). CMD lead to poor maternal and child health outcomes and contribute to lack of HIV care engagement and virologic failure in PPWH. While efficacious treatments for CMD exist, scaling treatment within routine health care in low- and middle-income (LMIC) settings will require stakeholder engagement and both effectiveness and implementation data to inform scale up and sustainability. Our team has integrated other efficacious interventions into antenatal (ANC) and HIV care in Kenya. We now propose to integrate proven mental health services using a collaborative care model, combined with a low intensity evidence-based intervention (problem solving therapy), while targeting known social determinants of HIV-related health for PPWH (stigma and IPV). Building on the current multidisciplinary approach for HIV care in Kenya, our proposed Collaborative Care Model (CCM) will utilize existing peer mentor mothers, non-specialist behavioral care managers, and psychiatric nurses; and will incorporate a consultant psychiatrist into the ANC/HIV care team. Guided by the EPIS (Exploration-Preparation-Implementation-Sustainment) framework, the overall study goal is to integrate collaborative care for perinatal CMD within routine ANC/HIV services in Kenya, assess the costs and cost-effectiveness of this approach, and work with policy and decision makers to determine key considerations for scale-up. Specifically, in Aim 1, we will identify contextual barriers and facilitators to refine an optimal integration model for delivering collaborative care model using multi- method data collection (focus groups with providers, in-depth interviews with key informants, and a clinic readiness checklist). A workshop with our Advisory Board comprising both county and national level stakeholders, will allow us to translate findings into a locally relevant CCM. In Aim 2 we will test CCM PPWH health during depression retention Aim 3, we will refine CCM implementation strategies through cost-effectiveness and dissemination research. We will carry out costing and cost-effectiveness analysis and invite policy and decision-makers to participate in a nominal group technique process to elucidate factors for further scale up and sustainment of the CCM approach. Findings from this study will developing a scalable model adaptable to other LMIC settings, contributing to global HIV and maternal health goals while and addressing the burden of untreated CMD. in antenatal care for in a hybrid type 2 implementation-effectiveness trial using a stepped wedge design at 15 primary care facilities in southwestern Kenya . We will i ntroduce CCM care for PPWH diagnosed with CMD antenatal care. The co-primary health outcomes at 12 months postpartum will be (1) recovery from or anxiety symptoms in PPWH, and (2) proportion PPWH with sustained viral suppression and in HIV care. Key implementation outcomes are feasibility and acceptability. Finally, in