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

描述（由申请人提供）：抗逆转录病毒治疗（ART）和预防母婴传播（PMTCT）项目在撒哈拉以南许多国家的大规模推广，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。拟议的研究将集中在生育与艾滋病毒自愿咨询和检测（VCT）和治疗的扩大以及个人对艾滋病毒感染及其后果的知识和看法的变化之间的交叉点。该项目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相邻农村地区开展的工作（R21HD048257, Agadjanian PI）为基础。该地区传统农业生计受到严重侵蚀，劳动力流动性巨大，婚姻和家庭制度发生深刻变化，艾滋病毒感染率高且不断上升，艾滋病毒/抗逆转录病毒/预防母婴传播得到大力推广。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认知如何影响她们的生育意愿、避孕选择和生育结果；农村妇女所处社会环境的特点如何影响上述关系；妇幼保健（MCH）诊所的体制特点和机制如何影响艾滋病毒阳性和艾滋病毒阴性农村妇女实现其生育意愿和避孕偏好的能力。该项目的另一个目的是根据这些分析拟订和传播实际的建议。

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.