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

描述(申请人提供)：获得抗逆转录病毒治疗(ART)的机会和有关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和生育率之间的双向关系。特别相关的是“方案B+”，这是一项旨在为艾滋病毒+孕妇提供普遍和终身获得抗逆转录病毒药物的机会的新方案。由于以前从未实施过这样的政策，备选方案B+提供了一个重要和直接的机会，让人们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)从生活在马拉维巴拉卡的大约3000名年轻人收集的2009-11年间的纵向数据基础上。具体地说，我们寻求现场TLT-2：对TLT-1的后续调查。TLT-2将关注受访者的生殖、关系、性、避孕和生物医疗服务使用史。最初的队列年龄将达到21-31岁--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数据集来回答关于女性、男性和夫妇的问题，在一个广泛和不断扩大的获得抗逆转录病毒治疗的环境中。特别是，我们将衡量这一新政策对艾滋病毒垂直传播(即母婴传播)和横向(即伴侣之间)传播以及这一群体的生育模式产生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结合在一起，审查地方一级新政策执行的现实情况。在了解艾滋病毒和生育率之间不断变化的关系--这是特别行政区生殖健康的一个关键方面--方面，这种以夫妇为基础和在体制上知情的综合办法将为研究和政策提供信息，为高流行率环境下的其他“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。

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.