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

描述（由申请人提供）：获得抗逆转录病毒治疗（ART）和艾滋病毒治疗的政策正在整个撒哈拉以南非洲（SSA）扩大。马拉维最近在治疗方面的改进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“备选方案B+"，这是一个新方案，旨在向艾滋病毒阳性孕妇提供普遍和终身的抗逆转录病毒疗法。由于这种政策以前从未实施过，方案B+提供了一个重要和直接的机会，可以了解广泛获得抗逆转录病毒疗法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。拟议的工作建立在Tsogolo la Thanzi（TLT-1）在2009- 11年间从马拉维巴拉卡约3000名年轻人中收集的纵向数据基础上。具体而言，我们寻求现场TLT-2：TLT-1的后续调查。TLT-2将侧重于受访者的生殖、关系、性、避孕和生物医学服务使用史。最初的队列年龄为21-31岁，是生育高峰期和艾滋病毒感染的急性风险。我们将利用TLT-2和合并的TLT-1/TLT-2数据集来回答有关广泛和扩大获得ART的环境中的女性，男性和夫妇的问题。特别是，我们将衡量这一新政策对垂直（即，母婴）和水平（即，艾滋病毒的传播和这一群体的生育模式。这些个人和夫妇层面的数据将与从诊所和政策制定者收集的新的详细数据相结合，这些诊所和政策制定者审查了地方一级新政策实施的现实情况。这种结合夫妇为基础的和机构知情的方法来了解艾滋病毒和生育之间的关系变化的生殖健康在SSA的一个重要方面，代表通知研究和政策，提供了一个初步的证据基础，其他的“测试和治疗”的政策，在高流行率的设置可能会影响生育行为和艾滋病毒的传播。

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.