Testing Culturally Tailored Peer Groups for HIV Prevention for Couples in Malawi

描述(由申请人提供)：这项顺序混合方法研究的总体目标是适应和测试一种文化上适当和有效的同龄人团体干预措施，以特别针对马拉维的夫妇进行艾滋病毒预防。已婚夫妇因婚前或婚后无保护的性行为而面临感染艾滋病毒的风险，越来越多的夫妇面临艾滋病毒状况不协调的问题。然而，目前还没有专门针对夫妇独特的艾滋病毒预防需求的艾滋病毒预防干预措施。长期以来，性别不平等一直被认为是已婚夫妇，特别是妻子预防艾滋病毒的障碍。然而，PI最近的论文研究发现，马拉维农村夫妇的实际决策比丈夫总是主导的简单剧本复杂得多。夫妻使用丈夫主导的文化剧本，但他们也使用其他三种文化剧本来支持共同决策：公开交流、保持和谐和儿童福利。大多数夫妇采取了丈夫主导、妻子主导和共同决策的混合模式。在第一阶段，这些被广泛接受的文化剧本和夫妇们已经广泛使用的共同决策方式将被纳入马拉维已经成功使用的现有的同龄人团体干预。这项夫妻同伴团体干预将为已婚夫妇的需求量身定做。还将制定针对夫妇的具体结果的衡量标准。在第二阶段，将试行干预措施。过程评估将记录干预措施的保真度、可接受性和可行性。对接受干预的已婚夫妇的短期影响进行结果评估，并与延迟控制组进行比较，使用三个月后的前测和后测。这项研究将在两个地区的四个低收入农村社区进行，一个实行母系婚姻制度，一个实行父系婚姻制度。假设将使用比例的二项式检验来检验两个结果，并对连续变量进行方差分析和对比分析。任何基线差异都将受到控制。我们将在基线时每组招募120对夫妇，80%的保留率最终样本将至少为每组96对夫妇。当α=0.05时，该样本将提供足够的能量(0.80)来确定连续变量的效应大小为0.35(中等效应)。这项拟议的研究是一项创新的科学进步，它将把文化上合适的夫妻决策、文化剧本和共享决策风格与基于行为变化理论的同龄人团体干预相结合。以社区为基础的参与性研究和对个人和夫妇两级成果的审查也是创新的。为已婚夫妇提供可接受和有效的艾滋病毒预防将对全球艾滋病毒预防具有重要意义。

DESCRIPTION (provided by applicant): The overall goal of this sequential mixed methods research is to adapt and test a culturally appropriate and effective peer group intervention for HIV prevention specifically for couples in Malawi. Married couples are at risk for HIV infection due to unprotected sex either before or after marriage, and a growing number of couples face the issue of discordant HIV status. However, no current HIV prevention interventions specifically address the unique HIV prevention needs of couples. Gender inequality has long been recognized as a barrier to HIV prevention for married couples, especially the wives. However, the Pi's recent dissertation research has found that the actual decision-making of couples in rural Malawi is more complex than a simple script where the husband always dominates. Couples used husband-dominant cultural scripts, but they also used three other cultural scripts to support shared decision-making: communicating openly, maintaining harmony, and children's welfare. Most couples used a mix of husband-dominated, wife dominated, and shared decision-making. In Phase I. these well-accepted cultural scripts and the shared decision-making style already widely used by couples will be integrated into an existing peer group intervention already used successfully in Malawi. This Couples Peer Group Intervention will be tailored for the needs of married couples. Measures of couple- specific outcomes will also be developed. In Phase II. the intervention will be piloted. A process evaluation will document fidelity, acceptability and feasibility of the intervention. An outcomes evaluation of short-term impacts of the intervention for married couples receiving the intervention compared to a delayed control group, using a pretest and a posttest at three months. The study will be conducted in four low income rural communities in two districts, one with a matrilineal and one with a patrilineal marriage system. Hypotheses will be tested using binomial tests of proportions for binary outcomes and analysis of variance with contrasts for continuous variables. Any baseline differences will be controlled for. We will recruit a total of 120 couples per group at baseline, and with an 80% retention rate the final sample will be at least 96 couples per group. With alpha=.05 this sample will give adequate power (.80) to identify an effect size of .35 for continuous variables (a medium effect). The proposed research is an innovative scientific advance that will integrate culturally appropriate couple decision-making cultural scripts and shared decision-making styles with peer group intervention based on behavioral change theory. The community-based participatory research and examination of both individual-level and couple-level outcomes is also innovative. An acceptable and effective HIV prevention for married couples will have high significance for global HIV prevention.