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）：截至 2007 年底，估计撒哈拉以南非洲地区有超过 1300 万妇女感染艾滋病毒/艾滋病。本研究的目的是评估艾滋病毒感染、生育结果和避孕措施之间的相互作用。乌干达拉凯的个人和夫妇中 ART 的可用性和使用情况。根据拟议的 RO1，我们计划分析自 1994 年以来每年对大约 12,000 名 Rakai 社区队列调查 (RCCS) 参与者进行的样本收集的数据。我们的具体目标是评估：(i) 避孕药具使用的决定因素和生育力的影响对避孕药具使用和怀孕率的愿望和意图，(ii) 激素避孕药对 HIV 疾病进展的影响以及 ART 对生育结果的影响，避孕药具的使用和高风险行为，以及 (iii) HIV 一致和血清不一致夫妇的生育结果和避孕药具使用。将通过年度调查和使用泊松回归估计的比率来评估避孕药具的使用率、怀孕率和流产率。对数二项式回归方法将用于评估避孕药具使用的决定因素。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、感染艾滋病的时间、CD4<250/mm3 的时间、CD4 下降、病毒设定点）和临床症状）。比例率模型将用于估计使用 ART 之前和之后女性怀孕频率和流产频率的变化。为了解释个体内的重复测量，我们将使用连续变量的随机效应模型，以及二元结果的马尔可夫和随机效应逻辑回归，并使用稳健方差的 GEE 估计。 RCCS 提供有关艾滋病毒状况、社会人口统计、行为和健康特征的独特纵向、基于社区的数据。迫切需要有关艾滋病毒感染妇女有效、长期避孕药具以及艾滋病毒治疗对生育结果、避孕药具使用和高危行为影响的数据。至关重要的是，更好地了解在艾滋病毒感染和抗逆转录病毒治疗的可用性和使用背景下影响生殖健康结果和避孕药具使用的因素，以便为政策和计划提供信息，指导个人和夫妇就性健康和生育问题做出更安全的决定。公共卫生相关性：乌干达的总生育率非常高（6.7），避孕药具使用率低（15.6%），而未满足的需求水平高（35%），因此迫切需要了解影响艾滋病毒预防决策的因素、避孕药具的使用和妊娠结局，以及这些因素因 ART 的可用性和使用而改变的程度。 RCCS 拥有数据来回答这些紧迫的公共卫生问题，涉及 HIV+ 和 HIV- 个人和夫妇的避孕选择和生育结果。