Assessing providers' reproductive counseling practice for South Africans with HIV

描述（由申请人提供）：背景-在撒哈拉以南非洲，稳定的、血清不一致的夫妇中的艾滋病毒传播可能占新发艾滋病毒感染的60%。许多艾滋病病毒感染者夫妇希望有孩子，但目前的预防计划并没有满足生育的愿望。生物医学预防方面的进展为大幅降低选择怀孕的个人感染艾滋病毒的风险创造了机会。拟议的工作重点是讨论卫生保健工作者（HCWs）和他们的HIV阳性患者之间的生育意愿，这是任何生殖咨询干预的关键第一步。 关于HCW和患者讨论生育计划的频率或有效性或成功讨论的障碍知之甚少。方法-我们将进行深入访谈，探讨在南非德班附近的公共部门诊所为艾滋病毒阳性男女提供生殖咨询的HCW（咨询师、护士、医生）的观点和做法。我们将采访从这些诊所寻求护理的HIV阳性男性和女性，以探索他们在生殖咨询方面的经验。定性数据和概念框架的患者提供者的沟通将告知调查工具; 120 HCW将进行调查，以评估频率和预测因子的生育意图评估与HIV+患者。创新-在艾滋病毒不和谐夫妇之间理想受孕的背景下尽量减少艾滋病毒传播是减少艾滋病毒横向和纵向传播的公共卫生优先事项。来自CAPRISA 004、iPrEX、HPTN 052、Partners PrEP和CDC TDF 2研究的数据表明，对HIV不一致夫妇的预防干预将包括局部或全身性ARV。为了设计有效的药物行为干预措施，有必要更好地了解HCWs目前的观点和实践。我们的行为科学（Bangsberg，Safren），艾滋病毒生殖健康（Harrison，Smit），干预发展（Psaros，Safren）和患者-提供者沟通（Wilson）专家团队将支持马修斯博士，一名初级研究员，在此背景下开展研究的良好记录，以了解艾滋病毒不和谐夫妇的围受孕风险行为和围受孕风险降低策略。意义-行为策略、包皮环切术、抗逆转录病毒治疗和暴露前抗逆转录病毒预防为艾滋病毒不一致的夫妇实现生育目标创造了机会，同时最大限度地降低了围产期艾滋病毒传播的风险。拟议的工作将导致对患者和HCW的经验的细致入微的理解，并将为干预措施的设计提供信息，以优化HCW对生育目标的评估和未来生殖咨询干预措施的实施。

DESCRIPTION (provided by applicant): Background- HIV transmission in stable, serodiscordant couples may account for up to 60% of new HIV infections in sub-Saharan Africa. Many HIV-discordant couples' desire children, yet current prevention programs do not accommodate fertility desire. Advances in biomedical prevention create opportunities to dramatically reduce the risk of HIV transmission for individuals who choose to conceive. The proposed work focuses on discussions of fertility intention between healthcare workers (HCWs) and their HIV-positive patients, a critical first step to any reproductive counseling intervention. Little is known about how often or effectively HCWs and patients discuss fertility plans or the barriers to successful discussions. Approach- We will conduct in-depth interviews to explore views and practices of HCWs (counselors, nurses, doctors) providing reproductive counseling to HIV+ men and women in public sector clinics near Durban, South Africa. We will interview HIV+ men and women seeking care from these clinics to explore their experiences with reproductive counseling. Qualitative data and a conceptual framework for patient-provider communication will inform a survey instrument; 120 HCWs will be surveyed to assess frequency and predictors of fertility intention assessment with HIV+ patients. Innovation- Minimizing HIV transmission in the context of desired conception among HIV- discordant couples is a public health priority to reduce horizontal and vertical HIV transmission. Data from CAPRISA004, iPrEX, HPTN 052, Partners PrEP, and CDC TDF2 studies demonstrate that a prevention intervention for HIV-discordant couples will include topical or systemic ARVs. A better understanding of HCWs' current views and practices of conception counseling is necessary in order to design effective pharmaco-behavioral interventions. Our team of experts in behavioral science (Bangsberg, Safren), HIV-reproductive health (Harrison, Smit), intervention development (Psaros, Safren), and patient-provider communication (Wilson) will support Dr. Matthews, a junior investigator with an excellent track record of carrying out research in this setting to understand periconception risk behavior and strategies for periconception risk reduction for HIV-discordant couples. Significance- Behavioral strategies, circumcision, antiretroviral therapy, and pre-exposure antiretroviral prophylaxis create opportunities for HIV-discordant couples to realize fertility goals while minimizing periconception HIV transmission risk. The proposed work will result in a nuanced understanding of the experiences of patients and HCWs and will inform design of interventions to optimize HCW assessment of fertility goals and implementation of future reproductive counseling interventions.