Understanding the role of food insecurity and depression in non-adherence to Option B+ among perinatal Kenyan women living with HIV: a Syndemics approach supplement

项目摘要/摘要 预防艾滋病毒母婴传播的战略可以降低垂直传播的风险 到不到2%，但在坚持防止母婴传播的三大支柱方面存在困难(母体艺术；独家 母乳喂养；向婴儿提供抗逆转录病毒治疗预防；即，备选方案B+)导致次区域母婴传播率高。 撒哈拉非洲和次优的母婴健康。拟议研究的目标是：1)获得 了解食物不安全(FI)和围产期抑郁的影响和机制 防止母婴传播备选案文B+不遵守的两个可修改的决定因素--相互作用影响备选案文B+遵守和 2)完善我们的概念框架，以帮助制定干预措施，帮助母亲保持选择 B+坚持。应聘者：我是一名护士科学家，有健康行为改变理论和 在艾滋病毒的背景下喂养婴儿。我正在申请K23职业发展奖，以获得培训， 导师和研究经验，成为一名以理论为基础的专家和独立研究员， 低资源地区艾滋病对母婴健康影响的多水平干预设计 设置。指导：我组建了一支在艾滋病毒方面拥有丰富经验的卓越指导团队 肯尼亚的治疗和预防研究。Sheri Weiser博士和Craig Cohen博士将担任联合小学 并提供艾滋病毒治疗和预防、妇幼保健、妇幼保健、 完善概念框架，并在肯尼亚制定和实施多层次干预措施。 我的联合导师和科学顾问将我的团队召集起来，为他们带来具体的内容和方法专业知识以及 总部设在美国和肯尼亚，包括：Mallory Johnson博士(临床心理学，多层次 干预设计和评估；可行性实施；ART依从性)；莫妮卡·甘地博士(临床 艾滋病毒管理，遵守客观艺术)；伊丽莎白·布库西博士(肯尼亚情况下的艾滋病毒，产妇 坚持)，Sera Young博士(母婴营养和预防母婴传播干预中的考虑因素 Tor Neilands博士(心理学、量化方法、纵向数据的设计和分析)。 培训：我建议接受FI、围产期艺术坚持、纵向定量研究设计和 分析，并以理论为基础的多层次干预开发与评价。将实现培训 通过导师会议、课程作业、研讨会、指导阅读和肯尼亚的初步研究。 研究：拟议研究的目标是：1)确定增加风险或预防风险的因素 HIV阳性孕妇孕期及产后FI与围产期抑郁的相关性研究 FI和围产期抑郁在现有的一组人群中随时间遵守预防母婴传播指南的情况 肯尼亚的围产期妇女；3)制定多层次的干预措施，并在 计划在第5年提交R01版本。

Project Summary/Abstract Strategies to prevent mother-to-child transmission (PMTCT) of HIV can reduce the risk of vertical transmission to less than 2%, but difficulties in adhering to the three pillars of PMTCT (maternal ART; exclusive breastfeeding; provision of ART prophylaxis to infant; i.e., Option B+) has led to high rates of MTCT in sub- Saharan Africa and suboptimal maternal and infant health. The goals of the proposed research are to 1) gain an understanding of the influences and mechanisms by which food insecurity (FI) and perinatal depression- two modifiable determinants of PMTCT Option B+ non-adherence-interact to impact Option B+ adherence and 2) refine our conceptual framework to aid in intervention development that assists mothers to maintain Option B+ adherence. Candidate: I am a nurse-scientist with a background in health behavior change theory and infant feeding in the context of HIV. I am applying for a K23 Career Development Award to obtain training, mentorship, and research experience to become an expert and independent investigator in theory-based, multi-level intervention design impacting maternal and infant health in the context of HIV in low-resource settings. Mentoring: I have put together an exceptional mentoring team with extensive experience in HIV treatment and prevention research in Kenya. Drs. Sheri Weiser and Craig Cohen will serve as co-Primary mentors and bring complementary expertise in HIV treatment and prevention, maternal and child health, FI, conceptual framework refinement, and development and implementation of multi-level interventions in Kenya. My co-mentors and scientific advisors round out my team to bring specific content and methods expertise and are based both in the U.S and in Kenya, including: Dr. Mallory Johnson (clinical psychology, multi-level intervention design and evaluation; feasibility implementation; ART adherence); Dr. Monica Gandhi (clinical management of HIV, objective ART adherence); Dr. Elizabeth Bukusi (HIV in the Kenyan context, maternal adherence), Dr. Sera Young (maternal and infant nutrition and FI, PMTCT considerations in intervention design), and Dr. Tor Neilands (psychology, quantitative methods, design and analysis of longitudinal data). Training: I propose to obtain training in FI, perinatal ART adherence, longitudinal quantitative study design and analysis, and theory-based multi-level intervention development and evaluation. Training will be achieved through mentor meetings, coursework, workshops, directed readings and primary research in Kenya. Research: The goals of the proposed research are to 1) identify factors that increase risk for or protect against FI and perinatal depression among HIV+ women during pregnancy and postpartum; 2) investigate the interplay of FI and perinatal depression on adherence to PMTCT guidelines over time among an existing cohort of perinatal women in Kenya; 3) develop a multi-level intervention and test feasibility with full scale testing in a planned R01 submission in year 5.