Determinants of Use of Safer Conception Strategies Among HIV Clients in Uganda

乌干达艾滋病毒感染者使用更安全受孕策略的决定因素

• 批准号: 8513382
• 负责人: GLENN John WAGNER
• 金额: $ 28.86万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-18 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8513382
• 关键词: AIDS/HIV problem; Address; Affect; Africa South of the Sahara; Artificial Insemination; Attitude; Belief; Child; Chronic Disease; Client; Clinic; Cohort Studies; Communication; Conceptions; Contraceptive Agents; Contraceptive methods; Counseling; Coupled; Couples; Decision Making; Development; Disease; Evaluation; Family Planning; Feeling; Female; Fertility; Fetus; HIV; HIV diagnosis; Health; Health Knowledge, Attitudes, Practice; Health Personnel; Healthcare Systems; Horizontal Disease Transmission; Individual; Insemination; Intention; Intervention; Interview; Knowledge; Lead; Life; Manuals; Methods; Outcome; Partner Communications; Patients; Persons; Phase; Pregnancy; Prevalence; Prevent viral transmission; Prevention; Provider; Readiness; Reproductive Health; Reproductive Health Services; Research; Resources; Risk; Risk Reduction; Role; Services; Sexual Transmission; Source; Staging; Stress; Surveys; Time; Training; Trust; Uganda; Unwanted pregnancy; Vertical Disease Transmission; antiretroviral therapy; child bearing; cost; cultural values; male; pregnant; prevent; prophylactic; prospective; reproductive; sperm cell; transmission process

DESCRIPTION (provided by applicant): With HIV becoming more of a chronic disease, desires and plans for childbearing has become increasingly prominent among persons living with HIV/AIDS (PLHA), especially in sub-Saharan Africa (SSA) where fertility is a strong cultural value. Pregnancy in PLHA involves both vertical and horizontal transmission risks, yet while there are considerable resources and support for patients to prevent unwanted pregnancy or once they become pregnant (e.g., PMTCT), services aimed at promoting safer conception are rarely available. Low cost safer conception strategies include antiretroviral therapy, timed unprotected intercourse, and manual insemination, but little known about the knowledge, acceptability and use of conception risk reduction methods among PLHA in SSA. HIV and family planning (FP) providers are a critical source of information and counseling for the reproductive health options for PLHA. Yet HIV providers often convey messages to PLHA that childbearing is inappropriate, are frequently constrained by feeling inadequately trained to offer effective counseling for safe conception, and so struggle with how to counsel patients when a risk of transmission to the partner is present. Similar issues may hold for FP providers, but this is even less studied. Consequently, patients may be uncomfortable discussing their fertility intentions and/or pregnancy with their providers. This breach in provider-patient trust and communication, coupled with an already over stressed health care system and cultural beliefs, lead many PLHA to seek advice from traditional healers (TH) who are more accessible, but often unprepared to fully address the HIV disease context. Research to date has focused on prevalence and correlates of fertility desires, with very little study of the use of pre- and post-conception risk reduction methods by PLHA. The proposed study will examine the reproductive decision making and use of conception risk reduction methods of HIV patients with fertility intentions, the knowledge, attitudes and practices of health providers regarding safer conception counseling for PLHA, and structural barriers to provision of support services. Phase 1 will be a formative evaluation of fertility planning and decision making through qualitative in-depth interviews with male and female HIV clients (and their partners) who have either recently conceived a child or have an intention to conceive; we will also interview HIV, FP and TH providers to examine knowledge, attitudes and practices related to childbearing support services for PLHA. Phase 2 will be an observational, prospective cohort study of 400 PLHA with fertility intentions who will be followed for 24 months to assess determinants of use of contraception (while waiting for the preferred time to conceive, and post-conception), pre-conception risk reduction methods, and PMTCT (when pregnant). Providers will also be surveyed longitudinally to assess changes in knowledge, attitudes, practices and structural barriers regarding provision of safer conception support over time. Findings from this study will inform the development of a structural intervention aimed at helping providers and clinics to better provide support needed by PLHA to have safer, healthy pregnancies, and limit transmission.

描述（由申请人提供）：随着艾滋病毒越来越成为一种慢性疾病，生育的愿望和计划在艾滋病毒/艾滋病（PLHA）感染者中变得越来越突出，特别是在撒哈拉以南非洲（SSA），生育是一种强烈的文化价值观。PLHA患者的妊娠涉及垂直和水平传播风险，然而，尽管有大量资源和支持患者预防意外妊娠或一旦怀孕（例如，预防母婴传播），很少提供旨在促进更安全受孕的服务。低成本的安全受孕策略包括抗逆转录病毒治疗、定时无保护性交和人工授精，但对SSA中PLHA降低受孕风险方法的知识、可接受性和使用知之甚少。艾滋病毒和计划生育（FP）提供者是PLHA生殖健康选择的重要信息和咨询来源。然而，艾滋病毒提供者经常向PLHA传达信息，即生育是不适当的，经常受到缺乏培训的约束，无法提供有效的安全受孕咨询，因此当存在传播给伴侣的风险时，如何为患者提供咨询。类似的问题可能适用于FP提供者，但这是更少的研究。因此，患者可能会不舒服讨论他们的生育意图和/或怀孕与他们的提供者。这种提供者与患者之间的信任和沟通的破坏，加上已经过度强调的卫生保健系统和文化信仰，导致许多PLHA向传统治疗师（TH）寻求建议，他们更容易获得，但往往没有准备好充分解决艾滋病毒疾病的背景。迄今为止的研究主要集中在生育意愿的普遍性和相关性上，很少研究怀孕前和怀孕后的风险 PLHA的减少方法。这项拟议的研究将审查生殖决策和使用的概念风险降低方法的艾滋病毒患者的生育意图，知识，态度和做法的卫生提供者关于更安全的概念咨询PLHA，和结构性障碍提供支持服务。第一阶段将是对生育计划和决策的形成性评估，通过对最近怀孕或有怀孕意图的男性和女性艾滋病毒客户（及其伴侣）进行定性深入访谈;我们还将采访艾滋病毒，FP和TH提供者，以检查与PLHA生育支持服务相关的知识，态度和做法。II期将是一项观察性、前瞻性队列研究，纳入400例有生育意愿的PLHA患者，随访24个月，以评估使用避孕措施（在等待首选受孕时间和受孕后）、孕前风险降低方法和PMTCT（妊娠时）的决定因素。还将对提供者进行纵向调查，以评估随着时间的推移，在提供更安全的受孕支持方面的知识、态度、做法和结构性障碍的变化。这项研究的结果将为制定结构性干预措施提供信息，旨在帮助提供者和诊所更好地提供PLHA所需的支持，以实现更安全，健康的妊娠并限制传播。