HIV/HAART and Pregnancy/Contraception in Rakai, Uganda

乌干达拉凯的 HIV/HAART 和怀孕/避孕

基本信息

批准号：
7685102
负责人：
HEENA Pushkar BRAHMBHATT
金额：
$ 27.89万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-12 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7685102
关键词：
AIDS prevention AIDS/HIV problem Accounting Acquired Immunodeficiency Syndrome Affect Africa Africa South of the Sahara Age Alcohol consumption Anti-Retroviral Agents Censuses Cessation of life Characteristics Child Clinical Cohort Studies Communities Contraceptive Agents Contraceptive Usage Contraceptive methods Counseling Couples Data Data Analyses Databases Developed Countries Developing Countries Disease Progression Equilibrium Family Family Planning Female Fertility Fertility Rates Frequencies Goals HIV HIV Infections HIV Seropositivity Health Health Sciences High Prevalence Highly Active Antiretroviral Therapy Hormonal Incidence Individual Infant Infection Infection of amniotic sac and membranes Intention Interview Knowledge Life Link Live Birth Logistic Regressions Low Birth Weight Infant Marital Relationships Measurement Measures Mediation Methods Modeling Mothers Opportunistic Infections Outcome Participant Persons Policies Population Pregnancy Pregnancy Outcome Pregnancy Rate Pregnancy loss Premature Birth Prevalence Prevention Prevention strategy Prophylactic treatment Public Health Relative (related person)Reproductive Health Risk Risk Behaviors Role Rural Community Sampling Serum Services Sexual Health Sexual Partners Social Marketing Stigmata Subgroup Surveys Survival Analysis Symptoms Testing Time Uganda Unwanted pregnancy Viral Woman abortion aged base behavioral health child bearing cohort condoms experience follow-up high risk behavior improved intimate partner violence male men optimism prevent programs public health relevance sex sex risk sexual coercion sexually active social stigma transmission process trend unintended pregnancy

项目摘要

DESCRIPTION (provided by applicant): Over 13 million women in sub-Saharan Africa were estimated to be infected with HIV/AIDS by end of 2007. The goal of this study is to assess the interactions between HIV infection, fertility outcomes and contraceptive use in the context ART availability and use among individuals and couples in Rakai, Uganda. Under the proposed RO1, we plan to analyze data collected annually on a sample of the approximately 12,000 Rakai Community Cohort Survey (RCCS) participants surveyed annually since 1994. Our specific aims are to assess: (i) determinants of contraceptive use and impact of fertility desires and intention on contraceptive use and pregnancy rates, (ii) impact of hormonal contraceptives on HIV disease progression as well as the impact of ARTs on fertility outcomes, contraceptive use and high risk behaviors, and (iii) fertility outcomes and contraceptive use among HIV-concordant and serodiscordant couples. Rates of contraceptive use, pregnancy, and pregnancy loss will be assessed through annual surveys and rate ratios estimated using Poisson regression. Log-binomial regression methods will be used to assess determinants of contraceptive use. Survival analyses and Kaplan-Meier survival curves will be used to assess the impact of hormonal contraceptives on HIV progression indicators (time from infection to death, time-to- AIDS, time to CD4 <250/mm3, and CD4 decline, viral set point and clinical symptoms). Proportional rate models will be used to estimate the within woman change in frequency of pregnancy and pregnancy loss before and after ART use. To account for repeat measurements within individuals we will use random-effects models for continuous variables and Markovian and random-effects logistic regression for binary outcomes with GEE estimation of robust variance. The RCCS provides unique longitudinal, community based data on HIV status, sociodemographic, behavioral and health characteristics. There is an urgent need for data on effective, long-term contraceptives for HIV-infected women and impact of HIV treatment on fertility outcomes, contraceptive use and high risk behaviors. It is critical that factors influencing reproductive health outcomes and contraceptive use in the backdrop of HIV infection and ART availability and use are better understood so as to inform policy and programs to guide individuals and couples make safer decisions regarding their sexual health and child bearing. PUBLIC HEALTH RELEVANCE: With a very high total fertility rate (6.7), low levels of contraceptive use (15.6%) and high levels of unmet need (35%) in Uganda, there is a pressing need to understand factors affecting decisions regarding HIV prevention, contraceptive use and pregnancy outcomes and the extent to which these factors are modified by ART availability and use. The RCCS has data to answer these pressing public health questions regarding contraceptive choices and fertility outcomes among HIV+ and HIV- individuals and couples.

描述（由申请人提供）：据估计，撒哈拉以南非洲以上的1300万妇女在2007年底之前感染了艾滋病毒/艾滋病。这项研究的目的是评估乌干达拉卡伊（Rakai）的个人和夫妻在上下文艺术上的可用性以及在上下文艺术上的可用性和使用中使用艾滋病毒感染，生育能力和避孕药的相互作用。根据拟议的RO1，我们计划分析每年每年收集的数据，以自1994年以来每年接受调查的大约12,000个Rakai社区同伴调查（RCCS）的参与者。我们的具体目的是评估：（i）避孕性使用的决定因素，以及对避孕药和怀孕的影响的避孕性欲望和意图对避孕药的影响的决定因素，以及（ii）对HOST的影响（II），以及II的影响，II偶然地影响了HESMONT的影响。生育能力结果，避孕药和高风险行为以及（iii）HIV-Concordant和Seriodiscordant夫妇的生育能力结果和避孕药的使用。避孕，妊娠和妊娠损失的速率将通过使用泊松回归估算的年度调查和速率比评估。对数二项式回归方法将用于评估避孕药使用的决定因素。生存分析和Kaplan-Meier生存曲线将用于评估激素避孕药对HIV进展指标的影响（从感染到死亡的时间，时间到死亡时间，CD4 <250/mm3的时间，CD4 <250/mm3和CD4下降，病毒设定点和临床症状）。比例率模型将用于估计妇女在使用艺术前后的怀孕频率和怀孕损失的频率内变化。为了说明个人内的重复测量值，我们将使用随机效应模型进行连续变量以及马尔可夫和随机效应的逻辑回归，以进行二进制结局，并具有GEE估计鲁棒方差。 RCC提供了有关HIV状况，社会人口统计学，行为和健康特征的独特纵向，基于社区的数据。迫切需要对感染HIV的妇女的有效长期避孕药的数据，以及HIV治疗对生育能力结果，避孕药使用和高风险行为的影响。至关重要的是，在艾滋病毒感染和艺术可用性的背景下影响生殖健康结果和避孕药的因素可以更好地理解，以便为政策和计划提供指导，以指导个人和夫妻就其性健康和孩子的承担做出更安全的决定。公共卫生相关性：由于总生育率非常高（6.7），避孕药的含量低（15.6％）和乌干达的高水平未满足需求（35％），因此有迫切的需求，需要了解影响预防HIV预防，避孕药的决策，避孕药的使用，以及这些因素因艺术可用性而改变的因素以及这些因素的范围。 RCC有数据可以回答有关艾滋病毒+和艾滋病毒和夫妇之间有关避孕的选择和生育成果的这些紧迫的公共卫生问题。