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

描述(申请人提供)：抗逆转录病毒疗法(ART)和预防母婴传播(PMTCT)计划在撒哈拉以南许多国家的大规模推出，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)和治疗的交集，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。它将结合不同类型的数据收集和分析，以研究小组之前在莫桑比克南部四个毗连农村地区的工作(R21HD048257，AgadjanianPI)为基础，这些地区传统的农业生计急剧侵蚀，劳动力大规模流动，婚姻和家庭制度的深刻变化，艾滋病毒的高流行率和不断增长，以及VCT/ART/PMTCT的大力扩展。这项研究的科学目的是在这种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她们的生育意愿、避孕选择和生育结果；农村妇女的社会环境特征如何影响上述关系；妇幼保健诊所的机构特征和机制如何影响艾滋病毒和艾滋病毒-农村妇女执行其生殖意图和避孕偏好的能力。该项目的另一个目的是在分析的基础上制定和传播切实可行的建议。 为了实现这些目标，这项为期五年的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。这两波调查将重新采访居住在54个村庄的约1680名已婚农村妇女的代表性样本，这些妇女最初是在2006年的一项研究中接受采访的。在进行个人调查的同时，将在每个村庄开展社区调查。除调查外，来自8个被抽样村庄(每个村庄9个)的72名受访者将参加两波深入访谈，他们在2006年进行了半结构化深入访谈。为了将个人/家庭和社区的观点与机构的观点相辅相成，在计划的每一年，将从各区的妇幼保健诊所收集有关妇幼保健/母婴传播服务提供和利用的统计数据，并将与诊所的护士进行深入访谈，重点讨论所涉及的挑战和障碍。该项目的成果将有助于更好地了解不断变化的艾滋病毒/艾滋病对生殖意向和行为的影响，优化母婴传播与预防母婴传播服务的结合，并改善农村妇女获得这些服务的机会。项目简介在莫桑比克艾滋病毒检测和治疗迅速增加的背景下，该项目将审查农村妇女对其艾滋病毒状况的了解或看法如何影响她们的生殖和避孕偏好、选择和结果。它将建立在研究小组以前在该国的工作的基础上，并将涉及收集和分析纵向人口调查、定性和机构数据。该项目的成果将增进对艾滋病毒/艾滋病与生育之间关系的了解，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。

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.