Prevention and Planning Linkages

预防和规划的联系

• 批准号: 8319109
• 负责人: JOHN S. SANTELLI
• 金额: $ 46.66万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8319109
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Africa South of the Sahara; Age; Agreement; Anti-Retroviral Agents; Behavior; Cohort Studies; Collaborations; Communities; Complement; Contraceptive Usage; Contraceptive methods; Counseling; Coupled; Couples; Data; Decision Making; Epidemic; Family Planning; Fertility; Fertility Determinant; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; Health Sciences; Human immunodeficiency virus test; Incidence; Individual; Infection; Interview; Investigation; Knowledge; Life; Measures; Mediation; Methods; Monitor; Outcome; Pattern; Perception; Phase; Planned Pregnancy; Policies; Population; Prevalence; Prevention; Prevention program; Primary Prevention; Process; Reproductive Health; Reproductive Process; Research; Research Personnel; Respondent; Risk Behaviors; Role; Rural; Services; Sexual Partners; Shapes; Social Characteristics; Time; Uganda; Variant; Vertical Disease Transmission; Woman; behavior change; case control; child bearing; cohort; conditioning; design; experience; improved; man; member; men; pregnancy prevention; programs; prospective; reproductive; sexually active; treatment program; trend; unintended pregnancy; young woman

DESCRIPTION (provided by applicant): Men and women in Sub Saharan Africa begin their reproductive lives facing the dual challenge of HIV infection and pregnancy planning. The Rakai district of Uganda represents a region where a generalized HIV epidemic has existed for the last two decades, where HIV prevalence is 11% and where the current unmet need for family planning is at 52%. Relatively stable HIV incidence coupled with treatment options means that today many people of reproductive age will live with HIV for many years. To date however, we know little about how HIV treatment and prevention shapes the fertility desires, behaviors, and outcomes of men, women, and couples - and how fertility influences HIV prevention. To address this gap, the proposed Prevention and Planning Linkages (Linkages) project first aims compare couples from four HIV concordant (both partners HIV+ or HIV-) and discordant groups (either sexual partner is HIV+) within the RCCS, examining men's and women's fertility desires, behaviors, and outcomes; agreement within couples; unmet need for contraception; and access to/utilization of HIV and RH services. Given the importance of both men and women in fertility decision-making, our investigations will focus on the role of both members of a couple in such decision-making. Using a mixed- method approach - used longitudinal cohort data and in-depth interviews with couples - we aim to provide a comprehensive perspective on the fertility desires, perceptions and behaviors of HIV concordant and discordant couples. Second, the Linkages project will explore trends in fertility desires, behaviors, and outcomes among HIV+ and HIV- women in relation to two phases of HIV prevention and treatment programs in Rakai: 1- post-availability of PMTCT and 2- post availability of ART. There is a dearth of research on fertility desires among a population-level cohort and how these desires have been affected by the changing dynamic of the HIV epidemic and treatment options. We will use historical data from sexually active women from the RCCS, to examine the trends in the fertility desires, behaviors and outcomes among HIV positive and HIV negative women over two phases of HIV treatment and prevention programs in rural Uganda. Finally, the Linkages project will identify trajectories i fertility desires and behaviors among women and men in the RCCS prior to and after seroconversion to infection, after seroconversion, and after gaining knowledge of personal or partner's infection. It is important to examine individual level variation in fertility desires and behaviors before and after HIV sero-conversion, as such a prospective analysis allows us to better understand the influence of HIV testing, HIV counseling and treatment on fertility related aspirations and behaviors, while conditioning on individual demographic and social characteristics. For this aim we will again use a mixed-method design - using longitudinal cohort data and matched 'case-control' qualitative interviews - to examine within-subject change among women and among men. PUBLIC HEALTH RELEVANCE: The proposed Planning and Prevention Linkages (Linkages) mixed-method study will explore the intersection of fertility desires, intentions, and behaviors among HIV positive and HIV negative men and women in rural Uganda. Using longitudinal quantitative data and qualitative data we will assess within couple differentials in fertility desie, perception and behaviors where partners are HIV discordant or concordant. We will also assess the changing trends in reproductive goals of women within the context of changing HIV programs and policies. And finally, we will use longitudinal quantitative and qualitative data to identify how fertility desires and behaviors change among men and women before they acquire HIV and after their HIV seroconversion.

描述（由申请人提供）：撒哈拉以南非洲的男女开始生殖生活，面临着艾滋病毒感染和妊娠计划的双重挑战。乌干达的Rakai区代表了一个地区，该地区在过去的二十年中一直存在普遍的艾滋病毒流行，艾滋病毒的患病率为11％，而目前对计划生育的未满足需求为52％。相对稳定的艾滋病毒发病率以及治疗方案意味着，今天许多生殖年龄的人都会患有艾滋病毒多年。但是，迄今为止，我们对艾滋病毒治疗和预防的了解一无所知。 为了解决这一差距，拟议的预防和计划联系（链接）项目首先是针对四个艾滋病毒一致的夫妇（伴侣艾滋病毒+或艾滋病毒或艾滋病毒）和不和谐的群体（性伴侣是艾滋病毒++），检查男性和女性的生育能力，行为，行为和结果；夫妻之间的协议；未满足避孕的需求；并获得/利用艾滋病毒和RH服务。鉴于男性和女性在生育决策中的重要性，我们的调查将集中于一对夫妻在这种决策中的作用。使用混合方法方法 - 使用纵向队列数据和与夫妻的深入访谈 - 我们旨在对HIV一致和不和谐的夫妇的生育欲望，看法和行为提供全面的观点。其次，连接项目将探讨HIV+和HIV妇女在Rakai的HIV预防和治疗计划的两个阶段的生育欲望，行为和结果的趋势：1- PMTCT的后可用性和2-术后艺术的可用性。人口级人群中的生育欲望以及这些欲望如何受到HIV流行和治疗选择的变化影响。我们将使用来自RCC的性活跃女性的历史数据来研究HIV阳性和HIV负面女性在乌干达农村艾滋病毒治疗和预防计划的两个阶段的艾滋病毒阳性和艾滋病毒负面女性中的生育欲望，行为和结果的趋势。最后，链接项目将在血清转化感染，血清转化后以及了解个人或伴侣感染后，在RCC中确定I的轨迹I的渴望和行为。重要的是要检查欲望的个体水平变化和 HIV血清转化之前和之后的行为，因此，这种前瞻性分析使我们能够更好地理解HIV测试，艾滋病毒咨询和治疗对与生育相关的愿望和行为的影响，同时遵守个人人口统计学和社会特征。为此，我们将再次使用混合方法设计 - 使用纵向队列数据并匹配“病例对照”定性访谈 - 检查女性和男性中的受试者内部变化。 公共卫生相关性：拟议的计划和预防联系（链接）混合方法研究将探讨乌干达农村地区HIV阳性和艾滋病毒负面男人和女性生育欲望，意图和行为的交集。使用纵向定量数据和定性数据，我们将在生育能力，感知和伴侣不一致或一致的伴侣中评估。我们还将在改变艾滋病毒计划和政策的背景下评估妇女生殖目标的变化趋势。最后，我们将使用纵向定量和定性数据来确定男性和女性在获得HIV和HIV血清转化后的欲望和行为的变化。