Couples in Context: An RCT of a Couples-based HIV Prevention Intervention

描述（由申请人提供）：南非15-49岁的成年人中艾滋病毒感染率为18%，产前门诊女性患者中为30%（联合国艾滋病规划署，2007年），表明继续需要有效的艾滋病毒预防。此外，最近在撒哈拉以南非洲的研究发现，60-94%的新艾滋病毒感染发生在婚姻或同居异性伴侣关系中（Dunkle等人，2008年）。这些发现表明需要针对南非夫妇进行艾滋病毒预防干预。本研究将测试行为干预计划的有效性，以增加生活在南非索韦托的夫妇的艾滋病毒检测。建议的理论为基础，文化上适当的干预包括六个会议（一个混合性别组，一个单一性别组和四个夫妻咨询会议）。采用350对异性恋夫妇的随机对照试验设计，我们将验证与单一的混合性别小组会议相比，提议的干预将改善沟通，亲密和信任，这将导致更好地沟通有关艾滋病毒风险和检测的问题，这反过来将提高夫妇协商安全性行为的能力，并增加他们参与艾滋病毒VCT的假设。干预措施是基于PI通过美国国立卫生研究院的K08奖在索韦托进行的初步研究。拟议的研究利用了PI开发的基础设施和合作关系，使她能够在索韦托社区内实施和开展研究。该项目的具体目的是测试基于理论和文化上适当的基于夫妻的干预对以下结果的有效性：艾滋病毒检测率。2. 有感染艾滋病毒风险的性行为（与主要伴侣和任何并发伴侣）。此外，我们将：3。评估假设的中介因素（例如，关系动力学）在多大程度上解释了主要结果，以及干预措施对这些因素的影响程度。

DESCRIPTION (provided by applicant): The prevalence for HIV in South Africa is 18% among 15-49 year old adults and 30% among female antenatal clinic attendees (UNAIDS, 2007), indicating continuing need for effective HIV prevention. Further, recent studies in sub-Saharan Africa found 60-94% of new HIV infections are occurring within marriage or co-habiting heterosexual partnerships (Dunkle et al., 2008). These findings signal the need for HIV prevention interventions that target couples in South Africa, This study will test the efficacy of a behavioral intervention program to increase HIV testing among couples living in Soweto, South Africa. The proposed theory-based, culturally appropriate intervention consists of six sessions (one mixed gender group, one single gender group, and four couples counseling sessions). Using a randomized controlled trial design with 350 heterosexual couples, we will test the hypothesis that compared with a single mixed gender group session, the proposed intervention will improve communication, intimacy and trust, which will lead to better communication about issues pertaining to HIV risk and testing, which in turn will improve couples' ability to negotiate safer sex and increase their participation in VCT for HIV. The intervention is based on preliminary research conducted by the PI via a K08 award from NIH, which was conducted in Soweto. The proposed study takes advantage of the infrastructure and collaborative relationships that the PI developed that enabled her to implement and conduct research within the Soweto community. The specific aims of the project are to test the efficacy of a theory-based and culturally appropriate couples- based intervention on the following outcomes: 1. Rates of testing for HIV. 2. Sexual risk behavior for HIV (with primary and any concurrent partners). In addition we will: 3. Evaluate the extent to which hypothesized mediating factors (e.g., relationship dynamics) explain the major outcomes and the extent to which the intervention affects these factors.