Assessing providers' reproductive counseling practice for South Africans with HIV

评估提供者对南非艾滋病毒感染者的生殖咨询实践

• 批准号: 8311934
• 负责人: Lynn T Matthews
• 金额: $ 8.12万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8311934
• 关键词: AIDS prevention; Abstinence; Accounting; Address; Adherence; Affect; Africa South of the Sahara; African; Ambulatory Care; Anti-Retroviral Agents; Artificial Insemination; Behavior Therapy; Behavioral; Behavioral Sciences; Centers for Disease Control and Prevention (U.S.); Child; Clinic; Clinical; Communication; Communities; Conceptions; Counseling; Couples; Cross-Sectional Studies; Data; Family Planning; Fertility; Frequencies; Fright; Future; Goals; HIV; HIV Infections; HIV Seropositivity; Health Personnel; Healthcare; Home environment; Human immunodeficiency virus test; Individual; Intention; Intervention; Intervention Studies; Interview; Judgment; Knowledge; Life; Male Circumcision; Methods; Nurses; Patient Care; Patients; Prevention; Prevention program; Prevention strategy; Preventive Intervention; Professional counselor; Prophylactic treatment; Protocols documentation; Provider; Public Sector; Reproductive Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Reduction; Services; South Africa; Structure; Support Groups; Surveys; Training; Unsafe Sex; Woman; Work; antiretroviral therapy; base; care seeking; clinical practice; condoms; demographics; design; experience; improved; innovation; insight; men; promoter; public health priorities; reproductive; reproductive health intervention; skills; therapy design; therapy development; transmission process

DESCRIPTION (provided by applicant): Background- HIV transmission in stable, serodiscordant couples may account for up to 60% of new HIV infections in sub-Saharan Africa. Many HIV-discordant couples' desire children, yet current prevention programs do not accommodate fertility desire. Advances in biomedical prevention create opportunities to dramatically reduce the risk of HIV transmission for individuals who choose to conceive. The proposed work focuses on discussions of fertility intention between healthcare workers (HCWs) and their HIV-positive patients, a critical first step to any reproductive counseling intervention. Little is known about how often or effectively HCWs and patients discuss fertility plans or the barriers to successful discussions. Approach- We will conduct in-depth interviews to explore views and practices of HCWs (counselors, nurses, doctors) providing reproductive counseling to HIV+ men and women in public sector clinics near Durban, South Africa. We will interview HIV+ men and women seeking care from these clinics to explore their experiences with reproductive counseling. Qualitative data and a conceptual framework for patient-provider communication will inform a survey instrument; 120 HCWs will be surveyed to assess frequency and predictors of fertility intention assessment with HIV+ patients. Innovation- Minimizing HIV transmission in the context of desired conception among HIV- discordant couples is a public health priority to reduce horizontal and vertical HIV transmission. Data from CAPRISA004, iPrEX, HPTN 052, Partners PrEP, and CDC TDF2 studies demonstrate that a prevention intervention for HIV-discordant couples will include topical or systemic ARVs. A better understanding of HCWs' current views and practices of conception counseling is necessary in order to design effective pharmaco-behavioral interventions. Our team of experts in behavioral science (Bangsberg, Safren), HIV-reproductive health (Harrison, Smit), intervention development (Psaros, Safren), and patient-provider communication (Wilson) will support Dr. Matthews, a junior investigator with an excellent track record of carrying out research in this setting to understand periconception risk behavior and strategies for periconception risk reduction for HIV-discordant couples. Significance- Behavioral strategies, circumcision, antiretroviral therapy, and pre-exposure antiretroviral prophylaxis create opportunities for HIV-discordant couples to realize fertility goals while minimizing periconception HIV transmission risk. The proposed work will result in a nuanced understanding of the experiences of patients and HCWs and will inform design of interventions to optimize HCW assessment of fertility goals and implementation of future reproductive counseling interventions. PUBLIC HEALTH RELEVANCE: Many HIV-discordant couples (one partner is HIV-infected, the other is not) take great risks to have children, as established prevention strategies do not account for fertility desires. Recent advances in HIV prevention offer potential strategies to reduce the risk of sexual HIV transmission while allowing for conception. We propose to study healthcare worker views towards, and knowledge and practices of providing reproductive counseling to HIV+ patients in South Africa in order to inform future intervention studies to improve healthcare worker skills for offering reproductive counseling strategies to HIV-affected patients.

描述（由申请人提供）：背景 - 稳定的艾滋病毒传播，血清旁的夫妇可能占撒哈拉以南非洲新艾滋病毒感染的60％。许多艾滋病毒夫妇的欲望孩子，但是当前的预防计划并不适应生育的欲望。生物医学预防的进步创造了机会，可以大大降低选择受孕的人的艾滋病毒传播风险。拟议的工作重点是讨论医疗工作者（HCW）及其HIV阳性患者之间生育意图的讨论，这是任何生殖咨询干预措施的关键第一步。 关于HCWS和患者讨论生育计划或成功讨论的障碍的频率或有效的频率或有效的人知之甚少。方法 - 我们将进行深入的访谈，以探索HCWS（辅导员，护士，医生）的观点和实践，为南非德班附近的公共部门诊所提供生殖咨询。我们将采访来自这些诊所的艾滋病毒+男女寻求护理，以探索他们在生殖咨询中的经验。定性数据和患者提供沟通的概念框架将为调查工具提供信息；将对120个HCW进行调查，以评估HIV+患者生育意图评估的频率和预测指标。创新 - 在艾滋病毒不一致的夫妻中所需构想的背景下，将艾滋病毒传播最小化是减少水平和垂直艾滋病毒传播的公共卫生优先事项。来自Caprisa004，IPREX，HPTN 052，Partners Prep和CDC TDF2研究的数据表明，对HIV-Discordant夫妇的预防干预将包括局部或系统性ARV。为了设计有效的药物行为干预措施，必须更好地了解HCWS的当前观点和构思咨询的实践。 Our team of experts in behavioral science (Bangsberg, Safren), HIV-reproductive health (Harrison, Smit), intervention development (Psaros, Safren), and patient-provider communication (Wilson) will support Dr. Matthews, a junior investigator with an excellent track record of carrying out research in this setting to understand periconception risk behavior and strategies for periconception risk reduction for HIV-discordant couples.显着性 - 行为策略，包皮环切术，抗逆转录病毒疗法和暴露前的抗逆转录病毒预防为HIV-Discordant夫妇提供了实现生育目标的机会，同时最大程度地减少了周期感受的HIV HIV传播风险。拟议的工作将使人们对患者和HCW的经历有细微的了解，并将为干预措施设计，以优化HCW的生育目标评估并实施未来的生殖咨询干预措施。 公共卫生相关性：许多艾滋病毒夫妇（一个伴侣是艾滋病毒感染的，另一个伴侣没有）有很大的风险生育孩子，因为既定的预防策略并不考虑生育能力的欲望。艾滋病毒预防的最新进展提供了潜在的策略，以减少允许受孕的同时降低性艾滋病毒传播的风险。我们建议研究医护人员对南非的艾滋病毒+患者提供生殖咨询的知识和实践的看法，以便为将来的干预研究提供信息，以提高医疗保健工作者的技能，从而为艾滋病毒影响患者提供生殖咨询策略。