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

描述（由申请人提供）：在许多撒哈拉以南非洲国家大规模开展抗逆转录病毒治疗（ART）和预防母婴传播（PMTCT）计划正在迅速而彻底地改变艾滋病毒/艾滋病的流行病学和社会意义和影响。拟议的研究将重点关注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。它将结合不同类型的数据收集和分析，以研究团队之前在莫桑比克南部四个连续农村地区的工作（R21HD048257，Agadjanian PI）为基础，这些地区传统农业生计急剧受到侵蚀，劳动力大量流动，婚姻和家庭制度发生深刻变化，艾滋病毒感染率高且不断增长，以及VCT/ART/PMTCT的大力扩展。该研究的科学目的是在这种不断变化的背景下考察：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（MCH）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实现其生育意愿和避孕偏好的能力。该项目的另一个目标是在分析的基础上制定和传播实用建议。 为了实现这些目标，这个为期五年的项目将采用纵向设计，其中涉及两波基于人口的调查和定性数据收集。两波调查将重新采访 c 的代表性样本。 2006 年的一项早期研究首次采访了居住在 54 个村庄的 1680 名已婚农村妇女。在个人调查的同时，还将在每个村庄开展社区调查。除调查外，来自 8 个样本村（每个村 9 名）的 72 名受访者（2006 年进行过半结构化深度访谈）将参加两波深度访谈。为了以机构视角补充个人/家庭和社区视角，在项目的每一年，将从各地区的妇幼保健诊所收集有关妇幼保健/VCT/PMTCT服务提供和利用的统计数据，并对诊所的护士进行重点关注所涉及的挑战和障碍的深入访谈。该项目的结果将有助于更好地了解不断变化的艾滋病毒/艾滋病形势对生殖意图和行为所造成的变化，并有助于优化母婴传播与 VCT/PMTCT 服务的整合，并改善农村妇女获得这些服务的机会。项目叙述 该项目将研究在莫桑比克艾滋病毒检测和治疗的可用性迅速增加的背景下，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之前在该国的工作的基础上，并将涉及纵向人口调查、定性和机构数据的收集和分析。该项目的成果将增进对艾滋病毒/艾滋病与生育关系的认识，有助于优化农村妇幼保健和预防艾滋病母婴传播服务。

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.