Understanding individual- and social network-level factors affecting infant HIV testing to design social network interventions to increase testing of HIV-exposed infants

项目总结/摘要 在负担沉重的撒哈拉以南非洲国家，每年有100多万婴儿感染艾滋病毒。然而 只有60%的受艾滋病毒感染的婴儿在两个月大时按建议接受了检测。婴儿的主要障碍 艾滋病毒检测-污名化/不披露、缺乏机会和社会支持不足-可能更有效 通过参与妇女社交网络的干预措施，克服妇女关系模式 与家人、同龄人和其他社区成员的关系。社交网络使突出的上下文规范， 使同伴学习，社会支持和社会参与，所有这些都可以影响健康行为。那里 在将社会网络分析应用于婴儿艾滋病毒检测方面仍然存在科学空白。在这一差距得到解决之前， 此外，在如何设计干预措施以吸引社会参与方面， 促进婴儿艾滋病毒检测的网络。这项资助计划的核心假设是，社交网络可以 影响妇女对婴儿进行艾滋病毒检测的决定。此K 01应用程序的主要目标是 了解妇女的个人和社会网络层面的特征如何影响婴儿艾滋病毒检测， 并评估社会网络干预改善婴儿艾滋病毒检测的可行性。的方法 利用正在进行的纵向研究（R 01 MH 113494，PI：Tsai）的基础设施， 网络来自乌干达姆巴拉拉8个村庄的所有成年人的数据，并将新的原始数据收集扩展到 所有艾滋病毒阳性的育龄妇女及其在研究期间出生的子女。这笔赠款将 实现以下具体目标：1）估计婴儿测试的个人和社会网络水平的相关性 通过社会网络分析，探讨了同伴影响、社会规范、社会支持和社会支持的作用。 （2）对妇女进行深入的定性访谈，并将调查结果与定量访谈相结合。 数据，以了解社会网络机制如何影响婴儿测试，并制定一个概念框架 3）设计和评估一个婴儿测试的可行性，可接受性，保真度，覆盖范围和初步有效性， 社会网络干预促进婴儿艾滋病毒检测。我的长期目标是成为一个独立的 研究员，在开发社会网络干预措施以加强艾滋病毒治疗和预防方面具有专业知识 撒哈拉以南非洲的妇女和儿童。此K 01提案将补充我之前的培训， 具有社会领域专业知识的高级研究人员团队的额外培训和指导经验 网络，定性和混合方法，以及应用于艾滋病毒背景下的实施科学。我会 获得R 01提案的综合培训、指导和初步数据，以实证检验一种新的 采取干预措施，克服婴儿艾滋病毒检测率低的公共卫生问题。这一创新的关键在于 这项研究是最早将社会网络理论和分析应用于婴儿艾滋病毒检测的研究之一。这 这一贡献将通过增加近一半的艾滋病毒检测来产生重大的公共卫生影响 在撒哈拉以南非洲，有100万名接触/未确诊的婴儿在两个月大时没有接受检测。

PROJECT SUMMARY/ABSTRACT More than one million infants are exposed to HIV each year in high-burden sub-Saharan African countries. Yet only 60% of HIV-exposed infants are tested as recommended by two months of age. The key barriers to infant HIV testing – stigma/non-disclosure, lack of access and poor social support – may be more effectively overcome through interventions that engage women's social networks, the patterns of relationships women have with family, peers, and other community members. Social networks make salient contextual norms and enable peer learning, social support, and social engagement, all of which can affect health behaviors. There remains a scientific gap in applying social network analysis to infant HIV testing. Until this gap is addressed, there will also remain an implementation knowledge gap on how to design interventions that engage social networks to prompt infant HIV testing. The central hypothesis of this proposed grant is that social networks can influence women's decisions to test their infants for HIV. The primary objective of this K01 application is to understand how women's individual- and social network-level characteristics affect infant HIV testing to design and assess the feasibility of a social network intervention to improve infant HIV testing. The approach leverages the infrastructure from an ongoing longitudinal study (R01MH113494, PI: Tsai) with complete social network data from all adults living in 8 villages of Mbarara, Uganda and extends new primary data collection to all HIV-positive, reproductive-age women and their children born during the study period. The grant will achieve the following specific aims: 1) estimate individual- and social-network level correlates of infant testing through social network analysis exploring the roles of peer influence, social norms, social support and social engagement; 2) conduct in-depth qualitative interviews among women and integrate findings with quantitative data to understand how social network mechanisms affect infant testing and develop a conceptual framework of infant testing; 3) design and assess feasibility, acceptability, fidelity, reach and preliminary effectiveness of a social network intervention to prompt infant HIV testing. My long-term goal is to become an independent researcher with expertise in developing social network interventions to enhance HIV treatment and prevention among women and children in sub-Saharan Africa. This K01 proposal will supplement my prior training and experience with additional training and mentorship from a team of senior researchers with expertise in social networks, qualitative and mixed methods, and implementation science applied to the context of HIV. I will obtain integrated training, mentorship, and preliminary data for an R01 proposal to empirically test a novel intervention to overcome the public health problem of low infant HIV testing. The key innovation of this proposed study is that it is one of the first to apply social network theory and analysis to infant HIV testing. This contribution will have significant public health impact by increasing uptake of HIV testing for the nearly one half million exposed/undiagnosed infants in sub-Saharan Africa who are not tested by two months of age.