Linking Individual Faith Together with My Highly Active Antiretroviral Therapy (LIFT My HAART): A Two-Phased Grant Proposal Open Access

Wilkinson, Lea (2016)

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The number of children newly infected by HIV in low- and middle-income countries has fallen by 40%. This constitutes considerable progress towards the global scale-up of Prevention of Mother-to-Child Transmission (PMTCT) initiatives. For the first time in history, the Elimination of Mother-to-Child Transmission (EMTCT) is an attainable public health goal. For the past decade, Zambia has successfully implemented an efficient nationwide response to the HIV/AIDS epidemic within its borders. During this time, Zambia has worked hard as a nation to achieve key milestones in the coordination and management of their national response. However, a concerning trend is starting to take hold within the country that threatens Zambia's success in PMTCT. Mounting pressure is present in some Christian communities for both men and women to stop Antiretroviral therapy (ART) for the hope that God will heal them through prayer. Women are statistically more drawn to churches that teach this belief, which contributes to their decision to stop ART. For an HIV-positive pregnant woman, the decision to substitute prayer for Highly Active Antiretroviral Therapy (HAART) could impact the life of her unborn child through mother-to-child transmission (MTCT) of HIV. To leverage the role that Christian religion plays in an HIV-positive pregnant woman's decision-making, as a way to ensure improved HAART adherence and reduced MTCT, this grant proposal outlines a two-phased process targeting HIV-positive pregnant women and Christian leaders in Lusaka, Zambia. The first phase is a mixed-method investigation of both HIV-positive pregnant women and the local Christian leaders in Lusaka, Zambia. The research will help identify the factors that may impact HAART treatment adherence among this population. The second phase uses information gathered through key informant interviews and surveys to aid in the creation of a community based program designed to Link Individual Faith Together with HAART (LIFT My HAART). The purpose of the initiative is to influence how HIV-positive pregnant women are counseled by those they look to for spiritual guidance. The goal is to increase treatment adherence for HIV-positive pregnant women who identify with the Christian faith.

Table of Contents

Chapter I: Part A 10

Introduction 10

Figure 1.1: Relationship Between ARV Coverage and MTCT Rate in Zambia from 2009-2012 12

The Problem 12

Understanding the Problem 13

Women in Zambia 13

Religion in Zambia 14

Figure 1.2: Religious Representation in Zambia 15

Chapter I: Part B 17

Introduction 17

Target Audience 18

The Research Question and Hypotheses 18

Actions Prior to the Start of the Grant Activities 19

Phase I 20

Figure 1.3: Phase I Sampling Grid 21

Qualitative and Quantitative Research 21

Selection of Interviewing Facilities 21

Key Informant Interviews and Surveys 22

Selection of Survey Participants 22

Survey and Interview Constructs 24

Survey Constructs 24

Interview Constructs 26

Reasons for Exclusion from the Interview and Survey Pool 27

HIV-positive pregnant women 27

Christian Leaders 28

Data Collection Activities 28

Figure 1.4: LIFT My HAART Program Activities 28

Analysis of Qualitative Data 29

Analysis of Quantitative Data 29

Data Usage 29

Phase II - Program Implementation of LIFT My HAART 30

LIFT My HAART Program Outline 30

Figure 1.5: Social-Ecological Model 32

Recruitment of LIFT My HAART Program Participants 32

LIFT My HAART Program Activities 33

Figure 1.6: LIFT My HAART Program Activities 33

LIFT My HAART Follow-up 33

Dissemination Plan 34

Potential Barriers 34

Risks 35

Chapter 1 Part B Summary 36

Definition of Terms 38

Chapter II: Review of Literature 41

Introduction 41

Review of Literature 41

Religion and Health Related Behaviors 41

Healing Churches 42

Healing Churches, Women, HIV and ART 43

Summary of Current Problem and Study Relevance 44

Types of Funding Agencies 45

Chapter III: Methodology 47

Grant Announcement 47

Proposal Review Criteria 47

Significance 48

Innovation 51

Approach 52

The Grant Review Process 55

LIFT My HAART Grant Reviewers 56

Johanna M. Hinman, MPH, MCHES 56

Beth Anne Pratt, PhD. 56

Wendy Zijdel, RN, CNS 57

Katy Weinberg, MBA, BA 57

Elizabeth Egelski, MPH, BA 58

Chapter IV: Incorporation of Reviewer Comments 59

Reviewer 1 Comments: 59

Reviewer 2 Comments: 66

Reviewer 3 Comments: 73

Reviewer 4 Comments: 80

Reviewer 5 Comments: 85

Chapter V: Final Version of the Proposal 93

References 103

Appendix A: RFP 108

Appendix B: External Reviewer Form 132

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