Prevention and Planning Linkages

预防和规划的联系

基本信息

批准号：
8469534
负责人：
JOHN S. SANTELLI
金额：
$ 44.23万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
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/8469534
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 HIV risk 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

项目摘要

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.

描述（由申请人提供）：撒哈拉以南非洲的男性和女性在开始生育生活时面临着艾滋病毒感染和怀孕计划的双重挑战。乌干达拉凯地区是过去二十年普遍存在艾滋病毒流行的地区，该地区艾滋病毒感染率为 11%，目前计划生育需求未得到满足的比例为 52%。相对稳定的艾滋病毒发病率加上治疗选择意味着如今许多育龄人群将感染艾滋病毒多年。然而，迄今为止，我们对艾滋病毒治疗和预防如何影响男性、女性和夫妇的生育愿望、行为和结果以及生育如何影响艾滋病毒预防知之甚少。为了解决这一差距，拟议的预防和规划联系（Linkages）项目的首要目标是比较 RCCS 内四个 HIV 一致群体（伴侣均为 HIV+ 或 HIV-）和不一致群体（性伴侣均为 HIV+）的夫妇，检查男性和女性的生育能力愿望、行为和结果；夫妻间的协议；避孕需求未得到满足；以及获得/利用艾滋病毒和生殖健康服务。鉴于男性和女性在生育决策中的重要性，我们的调查将重点关注夫妇双方在此类决策中的作用。使用混合方法——使用纵向队列数据和对夫妇的深入访谈——我们的目标是对艾滋病病毒一致和不一致的夫妇的生育愿望、看法和行为提供全面的视角。其次，联系项目将探讨与 Rakai 艾滋病毒预防和治疗计划两个阶段相关的 HIV+ 和 HIV- 妇女的生育愿望、行为和结果的趋势：1- 提供 PMTCT 后，2- 提供 ART 后。目前缺乏关于人群生育愿望以及这些愿望如何受到艾滋病毒流行动态和治疗方案变化影响的研究。我们将使用来自 RCCS 的性活跃妇女的历史数据，研究乌干达农村地区艾滋病毒治疗和预防计划两个阶段中艾滋病毒阳性和艾滋病毒阴性妇女的生育愿望、行为和结果的趋势。最后，联系项目将确定 RCCS 中女性和男性在血清转化为感染之前和之后、血清转化之后以及了解个人或伴侣感染情况之后的生育愿望和行为轨迹。重要的是检查生育愿望的个体水平差异和 HIV 血清转换之前和之后的行为，因为这样的前瞻性分析使我们能够更好地了解 HIV 检测、HIV 咨询和治疗对生育相关愿望和行为的影响，同时以个人人口和社会特征为条件。为此，我们将再次使用混合方法设计——使用纵向队列数据和匹配的“病例对照”定性访谈——来检查女性和男性的受试者内变化。