Implementing Comprehensive PMTCT and HIV Prevention for South African Couples

描述（由申请人提供）：2010年，在南非农村地区，在社区卫生中心寻求产前护理的艾滋病毒阳性孕妇中，只有三分之二充分利用了现有的“预防母婴传播”服务（南非卫生和发展组织）。虽然鼓励男性伴侣参与，作为增加预防母婴传播的一种潜在手段，但男性一直不愿陪伴妻子/伴侣进行产前保健。最近的研究普遍支持男性参与促进预防母婴传播，但这种参与的性质和影响尚不清楚，也未经检验。同样明显的是，污名化、信息披露和亲密伴侣暴力等因素对预防母婴传播的接受和保留构成重大障碍，这表明男性参与可能是“必要的，但不足以”实现世卫组织婴儿艾滋病毒发病率<5%的目标。可能需要采取其他措施来增加艾滋病毒阳性孕妇对预防母婴传播的参与。2011年，姆普马兰加省的艾滋病毒感染率为全国最高（36.7%），农村诊所的婴儿艾滋病毒感染率高达50%。该省的预防母婴传播接种率是南非最低的（69%）之一。这一申请旨在扩大在姆普马兰加省成功开展的由PEPFAR支持的预防母婴传播夫妇干预试点研究。“保护你的家人”)，以纳入更具代表性的艾滋病毒阳性孕妇及其伴侣，主要目标是确定男性伴侣参与加上行为干预是否会通过提高产前和产后对抗逆转录病毒/预防母婴传播方案的遵守程度，包括母乳喂养和计划生育，显著降低婴儿艾滋病毒发病率。拟议的研究将从12个随机分配的社区卫生中心招募两组艾滋病毒阳性孕妇（6个实验组，6个对照组）：a)没有男性伴侣参加的妇女（n = 720），其次是b)有男性伴侣参加的妇女（n = 720对夫妇），以确定男性参与本身的影响或与行为预防母婴传播干预相结合是否能显著降低婴儿在产前、围产期和产后的艾滋病毒感染。这是我们的。

DESCRIPTION (provided by applicant): In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available "prevention of mother-to-child transmission" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be "necessary, but not sufficient" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, ("Vikela Umndeni: Protect Your Family") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the "Vikela Umndeni: Protect Your Family" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.