Periconception HIV risk reduction for HIV-discordant couples in Uganda

乌干达艾滋病毒不一致夫妇的围孕期艾滋病毒风险降低

• 批准号: 8307304
• 负责人: Lynn T Matthews
• 金额: $ 16.7万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-26 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8307304
• 关键词: AIDS prevention; Abstinence; Accounting; Address; Adherence; Affect; Africa; Africa South of the Sahara; Age Factors; Anti-Retroviral Agents; Appointment; Artificial Insemination; Assisted Reproductive Technology; Award; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Belief; Biometry; Child; Clinic; Clinical; Clinical Investigator; Clinical Research; Clinical Trials Design; Commit; Communicable Diseases; Conceptions; Contraceptive methods; Counseling; Couples; Data; Development; Disclosure; Economics; Elements; Enrollment; Epidemiology; Family; Fellowship; Fertility; Future; General Hospitals; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Home environment; Immunosuppression; Incidence; Individual; Infection; Infectious Disease Epidemiology; Intervention; Intervention Studies; Intervention Trial; Interview; K-Series Research Career Programs; Life; Link; Literature; Male Circumcision; Manuscripts; Marital Status; Massachusetts; Measurement; Measures; Mediating; Medical; Medicine; Mental Depression; Mentors; Methods; Oral; Participant; Peer Review; Placebos; Population; Positioning Attribute; Pregnancy; Prevalence; Prevention; Prevention program; Prevention strategy; Process; Prophylactic treatment; Protocols documentation; Publications; Qualitative Methods; Randomized Controlled Trials; Recruitment Activity; Reporting; Reproductive Behavior; Reproductive Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Reduction; Safety; Sex Behavior; Spouses; Structure; Teaching Hospitals; Tenofovir; Testing; Time; Training; Training Support; Treatment outcome; Uganda; Universities; Unsafe Sex; Vagina; Viral Load result; Woman; Women' s Health; Work; antiretroviral therapy; base; career; child bearing; cohort; condoms; design; emtricitabine; experience; high risk; innovation; interest; meetings; men; novel; offspring; pregnant; prevent; public health priorities; reproductive; sex; skills; social capital; success; therapy design; transmission process

DESCRIPTION (provided by applicant): Background-HIV transmission in stable serodiscordant couples may account for up to 60% of new HIV infections in Africa. Many HIV-discordant couples desire children, yet prevention programs that focus on abstinence and condoms do not accommodate fertility desire. Antiretroviral therapy (ART) dramatically reduces sexual HIV transmission and recent successes with oral and topical pre-exposure prophylaxis (PrEP) hold promise for reducing transmission without preventing conception. My research seeks to develop combination HIV prevention strategies that accommodate the importance of having children for people living with HIV. Candidate-Seven peer-reviewed manuscripts (five first-author) reflect my commitment to HIV clinical research and a research interest that evolved from basic to behavioral science. During infectious disease fellowship, my primary research mentor, Dr. David Bangsberg, and I have worked to formalize research questions in the novel field of reducing HIV transmission in the setting of desired pregnancy. I am applying for a 5-year K23 Career Development Award to acquire needed skills and experience to become an independent investigator developing periconception risk-reduction strategies for HIV-discordant couples in sub-Saharan Africa. Mentoring-In July 2011, I will complete fellowship and accept an appointment as Assistant in Medicine in the Massachusetts General Hospital Division of Infectious Diseases. Dr. Bangsberg is an experienced and committed mentor with a record of over 50 trainees and over 160 publications. He will be my primary mentor and has protected time to support me through his K24 mentoring award. He has helped me to assemble an expert mentoring team including Steve Safren (behavioral science), Connie Celum and Jared Baeten (infectious disease, epidemiology), Jenni Smit (HIV reproductive health), Abigail Harrison (qualitative methods), Jerome Kabakyenga (HIV, women's health), and Heather Ribaudo (biostatistics). Research-Using existing data, I will examine prevalence and predictors of pregnancy and fertility desire among HIV-discordant Ugandan couples on ART for treatment or PrEP for prevention. I will examine how fertility desire and pregnancy impact periconception adherence to ART or PrEP. These data and qualitative work will inform iterative development of a pilot intervention to reduce periconception HIV transmission risk for discordant couples. This work will be grounded in a dyadic framework of periconception HIV-risk behavior. Training-The research is supported by training in quantitative methods focusing on repeated measures; qualitative methods focusing on in-depth interviews; behavioral science; and structured mentoring in adherence measurement and intervention design. The project will provide pilot data and training to develop an intervention trial to reduce periconception risk, to be proposed as an R01. My commitment to addressing these questions, an outstanding mentoring team, strong institutional support, and an innovative research plan that addresses a public health priority all position me to achieve my goal of becoming an independent clinical investigator.

描述（由申请人提供）：稳定的血清评估夫妇中的背景-HIV传播可能占非洲新艾滋病毒感染的60％。许多艾滋病毒夫妇渴望儿童，但专注于戒酒和避孕套的预防计划并不能满足生育能力的欲望。抗逆转录病毒疗法（ART）大大降低了性HIV传播，并通过口服和局部暴露前预防（PREP）取得了最新的成功，这有望减少传播而不会阻止构想。我的研究旨在制定艾滋病毒预防策略，以适应生育儿童对艾滋病毒感染者的重要性。候选人七个同行评审的手稿（五名第一任作者）反映了我对艾滋病毒临床研究的承诺，以及从基本行为科学发展的研究兴趣。在传染病奖学金期间，我的主要研究导师David Bangsberg博士和我一直在努力在减少所需怀孕期间减少艾滋病毒传播的新领域中形成研究问题。我正在申请为期5年的K23职业发展奖，以获得所需的技能和经验，成为一名独立的调查员，开发了撒哈拉以南非洲艾滋病毒遗嘱人群降低风险降低风险的策略。在2011年7月的指导中，我将完成奖学金，并接受马萨诸塞州综合医院传染病的医学助理的任命。 Bangsberg博士是一位经验丰富且坚定的导师，记录了50多名学员和160多个出版物。他将是我的主要导师，并有了通过他的K24指导奖来支持我的时间。他帮助我组建了一支专家指导团队，包括史蒂夫·萨夫伦（Cannie Celum），康妮·塞鲁姆（Connie Celum）和贾里德·贝滕（Jared Baeten）（传染病，流行病学），詹妮·史密特（Jenni Smit）（HIV生殖健康），阿比盖尔·哈里森（Abigail Harrison）（定性方法），Jerome Kabakyenga（Hiv，Hiv，Hiv，Hiv，Hiv，Hiv，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，HIV，妇女健康）和希瑟·里布多（Heather Ribaudo）（生物统计学）。研究 - 使用现有数据，我将研究乌干达夫妇在艺术治疗或预防准备方面的怀孕和生育欲望的普遍性和预测因素。我将研究生育能力和妊娠影响周围感受对艺术或准备的遵守。这些数据和定性工作将为试点干预的迭代开发提供信息，以减少对不一致夫妇的艾滋病毒传播风险。这项工作将基于周围感受的艾滋病毒风险行为的二元框架。培训 - 研究的支持，通过针对重复措施的定量方法培训支持；重点是深入访谈的定性方法；行为科学；以及依从性测量和干预设计中的结构化指导。该项目将提供试点数据和培训，以制定一项干预试验，以降低围皮风险，并提出为R01。我致力于解决这些问题，杰出的指导团队，强大的机构支持以及一项创新的研究计划，该计划旨在解决公共卫生的优先事项，所有这些都将我确定成为一名独立的临床研究者的目标。