Periconception HIV risk reduction for HIV-discordant couples in Uganda

描述（由申请人提供）：背景：在非洲，稳定的血清不一致夫妇的艾滋病毒传播可能占新发艾滋病毒感染的60%。许多hiv感染不一致的夫妇都想要孩子，然而注重节欲和避孕套的预防项目并不能满足生育的愿望。抗逆转录病毒疗法（ART）大大减少了艾滋病毒的性传播，最近在口服和局部暴露前预防（PrEP）方面取得的成功有望在不预防受孕的情况下减少传播。我的研究旨在制定综合艾滋病毒预防策略，以适应有孩子对艾滋病毒感染者的重要性。7篇同行评审的手稿（5篇第一作者）反映了我对HIV临床研究的承诺，以及从基础科学到行为科学的研究兴趣。在传染病研究期间，我的主要研究导师，大卫·班斯伯格博士，和我一起研究了在期望怀孕的情况下减少艾滋病毒传播的新领域的研究问题。我正在申请一个为期5年的K23职业发展奖，以获得所需的技能和经验，成为一名独立的调查员，为撒哈拉以南非洲的艾滋病毒不一致的夫妇制定降低围怀孕风险的策略。2011年7月，我将完成奖学金并接受马萨诸塞州总医院传染病科医学助理的任命。Bangsberg博士是一位经验丰富，忠诚的导师，有50多名学员和160多篇出版物。他将是我的主要导师，并通过他的K24导师奖抽出时间来支持我。他帮助我组建了一个专家指导团队，包括Steve Safren（行为科学）、Connie Celum和Jared Baeten（传染病、流行病学）、Jenni Smit（艾滋病毒生殖健康）、Abigail Harrison（定性方法）、Jerome Kabakyenga（艾滋病毒、妇女健康）和Heather Ribaudo（生物统计学）。研究——利用现有数据，我将检查艾滋病毒不一致的乌干达夫妇中接受ART治疗或PrEP预防的怀孕和生育意愿的患病率和预测因素。我将研究生育欲望和怀孕如何影响围怀孕期对ART或PrEP的依从性。这些数据和定性工作将为试点干预的迭代开发提供信息，以降低不一致夫妇的围怀孕期艾滋病毒传播风险。这项工作将以围孕期艾滋病毒风险行为的二元框架为基础。培训——本研究以重复测量为重点的定量方法培训为支撑；定性方法侧重于深度访谈；行为科学;以及在依从性测量和干预设计中的结构化指导。该项目将提供试点数据和培训，以制定一项干预试验，以降低围感风险，并将作为R01提出。我对解决这些问题的承诺，优秀的指导团队，强有力的机构支持，以及解决公共卫生优先事项的创新研究计划，都使我能够实现成为一名独立临床研究者的目标。

DESCRIPTION (provided by applicant): Background-HIV transmission in stable serodiscordant couples may account for up to 60% of new HIV infections in Africa. Many HIV-discordant couples desire children, yet prevention programs that focus on abstinence and condoms do not accommodate fertility desire. Antiretroviral therapy (ART) dramatically reduces sexual HIV transmission and recent successes with oral and topical pre-exposure prophylaxis (PrEP) hold promise for reducing transmission without preventing conception. My research seeks to develop combination HIV prevention strategies that accommodate the importance of having children for people living with HIV. Candidate-Seven peer-reviewed manuscripts (five first-author) reflect my commitment to HIV clinical research and a research interest that evolved from basic to behavioral science. During infectious disease fellowship, my primary research mentor, Dr. David Bangsberg, and I have worked to formalize research questions in the novel field of reducing HIV transmission in the setting of desired pregnancy. I am applying for a 5-year K23 Career Development Award to acquire needed skills and experience to become an independent investigator developing periconception risk-reduction strategies for HIV-discordant couples in sub-Saharan Africa. Mentoring-In July 2011, I will complete fellowship and accept an appointment as Assistant in Medicine in the Massachusetts General Hospital Division of Infectious Diseases. Dr. Bangsberg is an experienced and committed mentor with a record of over 50 trainees and over 160 publications. He will be my primary mentor and has protected time to support me through his K24 mentoring award. He has helped me to assemble an expert mentoring team including Steve Safren (behavioral science), Connie Celum and Jared Baeten (infectious disease, epidemiology), Jenni Smit (HIV reproductive health), Abigail Harrison (qualitative methods), Jerome Kabakyenga (HIV, women's health), and Heather Ribaudo (biostatistics). Research-Using existing data, I will examine prevalence and predictors of pregnancy and fertility desire among HIV-discordant Ugandan couples on ART for treatment or PrEP for prevention. I will examine how fertility desire and pregnancy impact periconception adherence to ART or PrEP. These data and qualitative work will inform iterative development of a pilot intervention to reduce periconception HIV transmission risk for discordant couples. This work will be grounded in a dyadic framework of periconception HIV-risk behavior. Training-The research is supported by training in quantitative methods focusing on repeated measures; qualitative methods focusing on in-depth interviews; behavioral science; and structured mentoring in adherence measurement and intervention design. The project will provide pilot data and training to develop an intervention trial to reduce periconception risk, to be proposed as an R01. My commitment to addressing these questions, an outstanding mentoring team, strong institutional support, and an innovative research plan that addresses a public health priority all position me to achieve my goal of becoming an independent clinical investigator.