Periconception HIV risk reduction for HIV-discordant couples in Uganda

描述（申请人提供）：背景-艾滋病毒在稳定的血清不一致的夫妇中传播可能占非洲新发艾滋病毒感染的60%。许多艾滋病病毒感染者夫妇都希望有孩子，但侧重于禁欲和避孕套的预防计划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，最近口服和局部暴露前预防（PrEP）的成功有望在不预防怀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战略，以适应艾滋病毒感染者生育子女的重要性。七篇同行评议的手稿（五篇是第一作者）反映了我对HIV临床研究的承诺，以及从基础科学发展到行为科学的研究兴趣。在传染病奖学金期间，我的主要研究导师大卫·邦斯伯格博士和我一起工作，以正式确定在期望怀孕的情况下减少艾滋病毒传播这一新领域的研究问题。我正在申请为期5年的K23职业发展奖，以获得必要的技能和经验，成为一名独立的调查员，为撒哈拉以南非洲的艾滋病毒不和谐夫妇制定减少围受孕风险的策略。2011年7月，我将完成奖学金，并接受任命为马萨诸塞州总医院传染病科医学助理。Bangsberg博士是一位经验丰富且忠诚的导师，拥有50多名学员和160多份出版物。他将是我的主要导师，并通过他的K24指导奖保护时间来支持我。他帮助我组建了一个专家指导团队，包括史蒂夫·萨夫伦（行为科学）、康妮·塞勒姆和贾里德·贝滕（传染病、流行病学）、詹尼·斯密特（艾滋病毒生殖健康）、阿比盖尔·哈里森（定性方法）、杰罗姆·卡巴金加（艾滋病毒、妇女健康）和石楠·里鲍多（生物统计学）。研究-使用现有数据，我将检查艾滋病毒不一致的乌干达夫妇对ART治疗或PrEP预防的怀孕和生育愿望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产期坚持ART或PrEP。这些数据和定性工作将告知迭代开发的试点干预措施，以减少围产期艾滋病毒传播的风险不和谐的夫妇。这项工作将扎根于一个二元框架的围受孕艾滋病毒的风险行为。培训-该研究得到了以下培训的支持：侧重于重复测量的定量方法;侧重于深入访谈的定性方法;行为科学;以及坚持测量和干预设计的结构化指导。该项目将提供试点数据和培训，以开发一项干预试验，以减少围产期风险，将被提议为R 01。我对解决这些问题的承诺，优秀的指导团队，强大的机构支持，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.