Childbearing Dynamics in Setting of High HIV Prevalence and Massive ART rollout

HIV 高感染率和大规模 ART 推广背景下的生育动态

• 批准号: 8282632
• 负责人: VICTOR AGADJANIAN
• 金额: $ 34.05万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-15 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282632
• 关键词: AIDS/HIV problem; Adherence; Affect; Africa South of the Sahara; Area; Attitude; Behavior; Characteristics; Child; Clinic; Collection; Communities; Community Surveys; Complement; Contraceptive Agents; Contraceptive Usage; Counseling; Country; Data; Data Analyses; Data Collection; Demographic Transitions; Development; Economics; Epidemic; Epidemiology; Ethnography; Family; Family Planning; Family Relationship; Fertility; Fertility Preferences; Fertility Study; HIV; HIV Infections; HIV Seropositivity; Health; Health Services Accessibility; Household; Human immunodeficiency virus test; Individual; Interview; Knowledge; Marriage and Family; Maternal and Child Health; Mediating; Mothers; Mozambique; Nature; Office Nursing; Outcome; Perception; Prevalence; Prevention; Prevention education; Public Health; Public Policy; Recommendation; Recording of previous events; Regimen; Research; Respondent; Rural; Sampling; Services; Social Characteristics; Social Environment; Social Network; Societies; Structure; Surveys; System; Testing; Time; Translating; Vertical Disease Transmission; Woman; Women' s Role; Work; antiretroviral therapy; authority; base; child bearing; cost; experience; family structure; follow-up; longitudinal design; population based; population survey; postnatal; preference; pregnant; prenatal; programs; reproductive; response; scale up; social; socioeconomics; theories; transmission process; trend

DESCRIPTION (provided by applicant): The massive rollout of antiretroviral therapy (ART) and of Prevention of Mother-to-Child Transmission (PMTCT) programs in many sub-Saharan countries is rapidly and radically changing the epidemiological and social meanings and implications of HIV/AIDS. The proposed study will focus on the intersections of childbearing with the scaling-up of HIV Voluntary Counseling and Testing (VCT) and treatment and resulting changes in individuals' knowledge and views about HIV infection and its consequences. It will combine different types of data collection and analysis to build upon the research team's previous work (R21HD048257, Agadjanian PI) in four contiguous rural districts of southern Mozambique, an area of precipitous erosion of traditional agrarian livelihoods, massive labor mobility, profound changes in marriage and family systems, high and growing HIV prevalence, and a vigorous expansion of VCT/ART/PMTCT. The scientific aims of the study are to examine in this changing context: how rural women's knowledge and perceptions of own HIV status affect their reproductive intentions, contraceptive choices, and fertility outcomes; how the characteristics of rural women's social environments influence the above relationships; how institutional characteristics and mechanisms of the Maternal and Child Health (MCH) clinics affect the ability of HIV+ and HIV- rural women to implement their reproductive intentions and contraceptive preferences. A separate aim of the project is to develop and disseminate practical recommendations on the basis of the analyses. To achieve these aims, the five-year project will use a longitudinal design that will involve two waves of population-based survey and of qualitative data collection. The two waves of survey will re-interview a representative sample of c. 1680 married rural women residing in 54 villages who were first interviewed for an earlier study in 2006. In parallel to the individual survey, in each village, a community survey will be carried out. In addition to the surveys, 72 of the survey respondents from eight of the sampled villages (nine per village), with whom semi-structured in-depth interviews were conducted in 2006, will participate in two waves of in- depth interviews. To complement the individual/household and community perspectives with an institutional one, in every year of the project, statistical data on MCH/VCT/PMTCT service provision and utilization will be collected from the districts' MCH clinics and in-depth interviews focusing on challenges and barriers involved will be carried out with the clinics' nurses. The results of the project will contribute to a better understanding of changes effected by the evolving HIV/AIDS landscape in reproductive intentions and behaviors and to the optimization of the integration of MTC with VCT/PMTCT services and improvement of rural women's access to these services. Project Narrative The project will examine how rural women's knowledge or perceptions of their HIV status affect their reproductive and contraceptive preferences, choices and outcomes in the context of rapidly increasing availability of HIV testing and treatment in Mozambique. It will build upon the research team's previous work in that country and will involve collection and analyses of longitudinal population survey, qualitative, and institutional data. The results of the project will advance the understanding of the relationships between HIV/AIDS and childbearing and will contribute to the optimization of rural maternal and child health and prevention of mother-to-child HIV transmission services.

描述（由申请人提供）：抗逆转录病毒疗法（ART）和预防母婴传播（PMTCT）计划在许多撒哈拉以南国家的大规模推广正在迅速和根本地改变艾滋病毒/艾滋病的流行病学和社会意义和影响。拟议的研究将侧重于生育与扩大艾滋病毒自愿咨询和检测（VCT）和治疗的交叉点，以及由此导致的个人对艾滋病毒感染及其后果的知识和看法的变化。它将结合联合收割机不同类型的数据收集和分析，以建立在研究小组以前在莫桑比克南部四个相邻农村地区的工作（R21 HD 048257，Agadjanian PI）的基础上，这是一个传统农业生计急剧侵蚀，劳动力大规模流动，婚姻和家庭制度发生深刻变化，艾滋病毒流行率高且不断增长，以及VCT/ART/PMTCT蓬勃发展的地区。研究的科学目的是在这一不断变化的背景下审查：农村妇女对自身艾滋病毒状况的了解和看法如何影响其生育意愿、避孕选择和生育结果;农村妇女的社会环境特点如何影响上述关系;妇幼保健诊所的机构特点和机制如何影响艾滋病毒+和艾滋病毒-农村妇女落实其生育意愿和避孕偏好。该项目的另一个目的是根据分析结果制定和传播切实可行的建议。 为实现这些目标，五年期项目将采用纵向设计，包括两波以人口为基础的调查和定性数据收集。两波调查将重新访问具有代表性的c。在2006年的一项早期研究中，对居住在54个村庄的1 680名已婚农村妇女进行了首次访谈。在进行个别调查的同时，还将在每个村庄进行社区调查。除了这些调查外，2006年进行了半结构化深入访谈的8个抽样村庄（每个村庄9个）的72名调查答卷人将参加两波深入访谈。为了从机构角度补充个人/家庭和社区的观点，在项目实施的每一年，将从地区妇幼保健诊所收集有关妇幼保健/自愿咨询和检测/预防母婴传播服务提供和利用的统计数据，并将与诊所护士进行深入访谈，重点是所涉及的挑战和障碍。该项目的成果将有助于更好地了解艾滋病毒/艾滋病状况的演变对生殖意图和行为的影响，并有助于优化母婴传播与自愿咨询和检测/防止母婴传播服务的整合，改善农村妇女获得这些服务的机会。该项目将研究在莫桑比克艾滋病毒检测和治疗迅速增加的情况下，农村妇女对其艾滋病毒状况的了解或看法如何影响其生殖和避孕偏好、选择和结果。它将以研究小组以前在该国的工作为基础，并将涉及收集和分析纵向人口调查、定性和机构数据。该项目的成果将促进对艾滋病毒/艾滋病与生育之间关系的理解，并将有助于优化农村妇幼保健和预防艾滋病毒母婴传播服务。