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、血清不一致的夫妇中的 HIV 传播可能占撒哈拉以南非洲新发 HIV 感染的 60%。许多艾滋病毒不一致的夫妇都渴望孩子，但目前的预防计划并不能满足生育愿望。生物医学预防的进步为选择怀孕的个人大幅降低艾滋病毒传播风险创造了机会。拟议的工作重点是医护人员 (HCW) 与其艾滋病毒阳性患者之间的生育意愿讨论，这是任何生殖咨询干预的关键第一步。 人们对医护人员和患者讨论生育计划的频率或效率以及成功讨论的障碍知之甚少。方法 - 我们将进行深入访谈，探讨在南非德班附近的公共部门诊所为艾滋病毒阳性男性和女性提供生殖咨询的医护人员（辅导员、护士、医生）的观点和做法。我们将采访从这些诊所寻求护理的艾滋病毒阳性男性和女性，以探讨他们在生殖咨询方面的经验。定性数据和患者与提供者沟通的概念框架将为调查工具提供信息；将对 120 名医护人员进行调查，以评估 HIV+ 患者生育意向评估的频率和预测因素。创新——在艾滋病毒不一致的夫妇中，在期望受孕的情况下最大限度地减少艾滋病毒传播是减少艾滋病毒横向和纵向传播的公共卫生优先事项。 CAPRISA004、iPrEX、HPTN 052、Partners PrEP 和 CDC TDF2 研究的数据表明，针对 HIV 不一致夫妇的预防干预措施将包括局部或全身抗逆转录病毒药物。为了设计有效的药物行为干预措施，有必要更好地了解医护人员当前对受孕咨询的看法和做法。我们的行为科学（Bangsberg、Safren）、艾滋病毒生殖健康（Harrison、Smit）、干预开发（Psaros、Safren）和患者与提供者沟通（Wilson）方面的专家团队将为 Matthews 博士提供支持，他是一名初级研究员，具有在这种情况下开展研究以了解艾滋病毒不一致夫妇的围孕期风险行为和降低围孕期风险的策略的记录非常出色。意义——行为策略、包皮环切术、抗逆转录病毒治疗和暴露前抗逆转录病毒预防为艾滋病毒不一致的夫妇创造了实现生育目标的机会，同时最大限度地降低围孕期艾滋病毒传播风险。拟议的工作将导致对患者和医务人员的经历有细致入微的了解，并将为干预措施的设计提供信息，以优化医务人员对生育目标的评估和未来生殖咨询干预措施的实施。 公共卫生相关性：许多艾滋病毒不一致的夫妇（一方感染艾滋病毒，另一方未感染）冒着巨大的风险生育孩子，因为既定的预防策略没有考虑到生育愿望。艾滋病毒预防方面的最新进展提供了在允许受孕的同时降低艾滋病毒性传播风险的潜在策略。我们建议研究南非医护人员对向艾滋病毒+患者提供生殖咨询的看法、知识和实践，以便为未来的干预研究提供信息，以提高医护人员为艾滋病毒感染者提供生殖咨询策略的技能。