The Relationship Between HIV and Fertility in a Context of Expanding ART Access

描述（由申请人提供）：抗逆转录病毒治疗（ART）的可及性和艾滋病毒治疗政策正在整个撒哈拉以南非洲（SSA）扩大。马拉维最近治疗情况的改善将改变非洲艾滋病毒与生育率之间的双向关系。特别相关的是“B+方案”，这是一项旨在向孕妇和艾滋病毒阳性妇女提供普遍和终身获得抗逆转录病毒治疗的新规划。由于以前从未实施过这样的政策，方案B+提供了一个重要而直接的机会，可以了解广泛获得抗逆转录病毒治疗对生殖目标和行为的影响以及对艾滋病毒传播的连锁反应。这项提议的工作建立在Tsogolo la Thanzi （TLT-1）在2009年至2011年间收集的大约3000名生活在马拉维巴拉卡的年轻人的纵向数据基础上。具体来说，我们寻求对TLT-2的实地调查：对TLT-1的后续调查。TLT-2将侧重于调查对象的生殖、关系、性、避孕和生物医学服务使用史。最初的队列将是21-31岁的生育高峰期和艾滋病毒感染的急性风险。我们将利用TLT-2和联合的TLT-1/TLT-2数据集来回答在广泛和不断扩大获得抗逆转录病毒治疗的环境中有关女性、男性和夫妇的问题。特别是，我们将衡量这一新政策对纵向（即母婴）和横向（即伴侣之间）艾滋病毒传播以及这一群体的生育模式的预期和可能的意外后果。这些个人和夫妻层面的数据将与从诊所和政策制定者那里收集的新的详细数据相结合，这些数据将审查地方层面新政策实施的现实情况。这种以夫妻为基础和机构知情的方法结合起来，了解艾滋病毒与生育能力之间不断变化的关系——这是ssa生殖健康的一个重要方面——通过为高流行环境中其他“检测和治疗”政策如何影响生育行为和艾滋病毒传播提供初步证据基础，为研究和政策提供信息。

DESCRIPTION (provided by applicant): Access to antiretroviral therapy (ART) and policies around HIV treatment are expanding throughout sub- Saharan Africa (SSA). Recent improvements in the treatment context in Malawi stand to alter the bi-directional relationship between HIV and fertility in Africa. Of particular relevance is "Option B+", a new program designed to provide universal and lifelong access to ART to pregnant, HIV+ women. Because such a policy has never been implemented before, Option B+ offers an important and immediate opportunity to learn about the implications of widespread ART access for reproductive goals and behaviors and the knock-on effects for HIV transmission. The proposed work builds upon longitudinal data collected by Tsogolo la Thanzi (TLT-1) between 2009-11from approximately 3000 young adults living in Balaka, Malawi. Specifically, we seek to field TLT-2: a follow up survey of the TLT-1. TLT-2 will focus on respondents' reproductive, relationship, sexual, contraceptive, and biomedical service use histories. The original cohort will have aged to 21-31-years of peak childbearing and acute risk for HIV infection. We will leverage TLT-2 and the combined TLT-1/TLT-2 dataset to answer questions about women, men, and couples in an environment of widespread and expanding access to ART. In particular, we will measure the expected and possible unanticipated consequences of this new policy on both vertical (i.e., mother-to-child) and horizontal (i.e., between partners) HIV transmission and on patterns of fertility for this cohort. These individual- and couple-level data will be combined with new detailed data collected from clinics and policymakers examining the realities of new policy implementation at the local level. This combined couple-based and institutionally informed approach to understanding the changing relationship between HIV and fertility-a crucial dimension of reproductive health in SSA-stands to inform both research and policy by providing a preliminary evidentiary basis for how other "test and treat" policies in high-prevalence setting might influence fertility behavior and HIV transmission.