Developing and Assessing a Male Engagement Intervention for Option B+ in Malawi

描述（由申请人提供）： 候选人：我是一名传染病流行病学家，致力于通过艾滋病毒综合预防在资源有限的环境中减少艾滋病毒的发病率。我的职业目标是成为一名流行病学教授，拥有强大的艾滋病预防研究组合。作为一名接触行为科学的流行病学家，我完全有能力实现这一目标。然而，为了成功地竞争R 01基金，我将受益于一个短暂的指导培训和研究。我在行为研究的设计和分析方面有丰富的经验，但在理论驱动的行为干预的设计和交付方面的经验有限。在为期两年的指导阶段，我的培训和研究活动将集中在培养设计和提供理论驱动的行为干预的技能。为了实现这一目标，我组建了一个杰出的导师团队：William C.米勒（主要导师）、Mina Hosseinipour博士（主要共同导师）和Nuala麦格拉思、Carol Golin和Suzanne Maman博士（共同导师）。该小组的所有成员在撒哈拉以南非洲艾滋病毒综合预防方法的设计、实施和评价方面都取得了多产的科学成就和丰富的经验。他们致力于支持我并相互合作。指导阶段研究（K99，1-2年）：在撒哈拉以南非洲，迫切需要增加男性艾滋病毒检测并使他们参与艾滋病毒预防，护理和治疗的战略。这种参与可为感染艾滋病毒的男子带来治疗益处，为未感染艾滋病毒的男子带来预防益处，并为其感染艾滋病毒的女性伴侣带来治疗益处。选项B+是马拉维在诊断时向所有感染艾滋病毒的孕妇提供立即、终身联合抗逆转录病毒治疗（cART）的方案，是让男性伴侣参与护理的一个有希望的环境。在选项B+中，我将开发一种干预措施，使用合同合作伙伴通知来招募 男性伴侣，然后让他们与感染艾滋病毒的女性伴侣一起参与以夫妇为基础的干预（目标1）。干预措施将以形成性研究和二元相互依赖理论为指导，旨在改善与艾滋病毒感染男性伴侣护理的联系，预防未感染艾滋病毒的男性伴侣感染艾滋病毒，并促进感染艾滋病毒的女性伴侣继续接受cART治疗。 独立阶段研究（R 00，3-5年）：我将进行一项随机对照试验（N=500对夫妇），以评估一年后的干预有效性。我将评估该干预措施是否增加了艾滋病毒检测和艾滋病毒感染男性性伴侣之间的护理联系（目标2）;确定艾滋病毒不一致的夫妇，并降低未感染艾滋病毒的男性性伴侣接触艾滋病毒的可能性（目标3）;以及改善所有女性伴侣的cART保留和病毒抑制（目标4）。未来方向：R 00结果将为R 01提供更长期的病毒抑制和HIV发病率结果。我将从一个指导博士后研究助理过渡到一个独立的调查员，能够设计行为干预和领导艾滋病毒预防试验的组合。

DESCRIPTION (provided by applicant): Candidate: I am an infectious diseases epidemiologist committed to reducing HIV incidence in resource- limited settings through combination HIV prevention. My career goal is to be an epidemiology professor with a robust combination HIV prevention research portfolio. As an epidemiologist with behavioral science exposure, I am well positioned to achieve this goal. However, to compete successfully for R01 funding, I would benefit from a brief period of mentored training and research. I have extensive experience in the design and analysis of behavioral research, but limited experience in the design and delivery of theory-driven behavioral interventions. In a two-year mentored phase, both my training and research activities will focus on cultivating skills for designing and delivering theory-driven behavioral intervention. I have assembled an exceptional team of mentors to support this goal: Dr. William C. Miller (primary mentor), Dr. Mina Hosseinipour (primary co- mentor), and Drs. Nuala McGrath, Carol Golin, and Suzanne Maman (co-mentors). All members of the team have prolific scientific accomplishments and extensive experience in the design, implementation and evaluation of combination HIV prevention approaches in sub-Saharan Africa. They are committed to supporting me and collaborating with each other. Mentored Phase Research (K99, years 1-2): In sub-Saharan Africa, strategies to increase HIV testing among men and engage them in HIV prevention, care, and treatment are urgently needed. Such engagement can have treatment benefits for HIV-infected men, prevention benefits for HIV-uninfected men, and treatment benefits for their HIV-infected female partners. Option B+, Malawi s program for providing immediate, lifelong combination antiretroviral therapy (cART) to all HIV-infected pregnant women at the time of diagnosis, is a promising setting for engaging male partners in care. Within Option B+, I will develop an intervention that uses contract partner notification to recruit male partners and then engage them in a couple-based intervention with their HIV-infected female partner (Aim 1). The intervention will be guided by formative research and the dyad-level Interdependence Theory and aimed at improving linkage to care for HIV-infected male partners, preventing HIV acquisition for HIV-uninfected male partners, and promoting cART retention for HIV-infected female partners. Independent Phase Research (R00, Years 3-5): I will conduct a randomized controlled trial (N=500 couples) to assess intervention effectiveness at one year. I will assess whether the intervention increases HIV testing and linkage to care among HIV-infected male sex partners (Aim 2); identifies HIV-discordant couples, and decreases the likelihood of HIV exposure for HIV- uninfected male sex partners (Aim 3); and improves cART retention and viral suppression for all female partners (Aim 4). Future Directions: The R00 results will inform an R01 with longer-term viral suppression and HIV-incidence outcomes. I will transition from a mentored postdoctoral research associate to an independent investigator capable of designing behavioral interventions and leading combination HIV prevention trials.