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

描述（由申请人提供）：这种顺序混合方法研究的总体目标是适应和测试文化上适当和有效的同龄群体干预艾滋病毒预防，特别是在马拉维的夫妇。已婚夫妇由于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一致的问题。然而，目前没有任何艾滋病毒预防干预措施专门针对夫妇独特的艾滋病毒预防需求。长期以来，两性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占主导地位的简单脚本更为复杂。夫妻使用丈夫主导的文化脚本，但他们也使用其他三种文化脚本来支持共同决策：公开沟通，保持和谐，以及儿童福利。大多数夫妻都是丈夫主导、妻子主导和共同决策的混合体。在第一阶段。这些广为接受的文化脚本和夫妻之间已经广泛采用的共同决策方式将被纳入马拉维已经成功使用的现有同龄群体干预措施。这对夫妇的同龄群体干预将适合已婚夫妇的需要。还将制定夫妇特定结果的衡量标准。在第二阶段。干预措施将试行。过程评价将记录干预的保真度、可接受性和可行性。结果评估的短期影响的干预已婚夫妇接受干预相比，延迟控制组，使用前测和后测在三个月。这项研究将在两个地区的四个低收入农村社区进行，一个是母系婚姻制度，一个是父系婚姻制度。将使用二元结局的比例二项式检验和连续变量的对比方差分析来检验假设。将控制任何基线差异。我们将在基线时招募每组共120对夫妇，在留存率为80%的情况下，最终样本将为每组至少96对夫妇。当α = 0.05时，该样本将提供足够的把握度（0.80），以确定连续变量的效应量为0.35（中等效应）。拟议的研究是一项创新的科学进步，将整合文化上适当的夫妇决策文化脚本和共享的决策风格与同龄人群体干预的基础上，行为改变理论。以社区为基础的参与性研究以及对个人和夫妇两级结果的审查也是创新性的。一个可接受的和有效的预防艾滋病的已婚夫妇将有很高的意义，全球艾滋病预防。

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.