Couples in Context: An RCT of a Couples-based HIV Prevention Intervention

描述（由申请人提供）：在南非，15-49岁的成年人中艾滋病毒的流行率为18%，女性产前诊所就诊者中为30%（联合国艾滋病规划署，2007年），这表明仍然需要有效的艾滋病毒预防。此外，最近在撒哈拉以南非洲的研究发现，60-94%的新艾滋病毒感染发生在婚姻或同居的异性伴侣关系中（Dunkle等人，2008年）。这些发现表明，需要针对南非夫妇的艾滋病毒预防干预措施，这项研究将测试行为干预计划的有效性，以增加生活在南非索韦托的夫妇的艾滋病毒检测。 建议的理论为基础的，文化上适当的干预包括六个会议（一个混合性别组，一个单一性别组，和四个夫妇咨询会议）。使用随机对照试验设计与350异性恋夫妇，我们将测试的假设相比，一个单一的混合性别组会议，拟议的干预措施将改善沟通，亲密和信任，这将导致更好的沟通有关的问题，艾滋病毒的风险和测试，这反过来又会提高夫妇的能力，协商安全性行为，并增加他们的参与艾滋病毒自愿咨询检测。 该干预措施基于PI通过NIH的K 08奖在索韦托进行的初步研究。拟议的研究利用PI开发的基础设施和合作关系，使她能够在索韦托社区内实施和开展研究。该项目的具体目标是测试基于理论和文化上适当的夫妇为基础的干预措施对以下结果的效力：1。艾滋病毒检测率。 2.艾滋病毒的性风险行为（与主要和任何共同伴侣）。此外，我们将：3。评估假设的中介因素（例如，关系动态）解释了主要结果以及干预措施对这些因素的影响程度。 公共卫生相关性：拟议的干预措施将在南非索韦托进行，这是一个受艾滋病毒流行影响严重的地区。该项目旨在增加参与干预措施的夫妇通过自愿咨询和检测了解自己及其伴侣艾滋病毒状况的可能性，并减少可能使他们面临艾滋病毒风险的性风险行为。

DESCRIPTION (provided by applicant): The prevalence for HIV in South Africa is 18% among 15-49 year old adults and 30% among female antenatal clinic attendees (UNAIDS, 2007), indicating continuing need for effective HIV prevention. Further, recent studies in sub-Saharan Africa found 60-94% of new HIV infections are occurring within marriage or co-habiting heterosexual partnerships (Dunkle et al., 2008). These findings signal the need for HIV prevention interventions that target couples in South Africa, This study will test the efficacy of a behavioral intervention program to increase HIV testing among couples living in Soweto, South Africa. The proposed theory-based, culturally appropriate intervention consists of six sessions (one mixed gender group, one single gender group, and four couples counseling sessions). Using a randomized controlled trial design with 350 heterosexual couples, we will test the hypothesis that compared with a single mixed gender group session, the proposed intervention will improve communication, intimacy and trust, which will lead to better communication about issues pertaining to HIV risk and testing, which in turn will improve couples' ability to negotiate safer sex and increase their participation in VCT for HIV. The intervention is based on preliminary research conducted by the PI via a K08 award from NIH, which was conducted in Soweto. The proposed study takes advantage of the infrastructure and collaborative relationships that the PI developed that enabled her to implement and conduct research within the Soweto community. The specific aims of the project are to test the efficacy of a theory-based and culturally appropriate couples- based intervention on the following outcomes: 1. Rates of testing for HIV. 2. Sexual risk behavior for HIV (with primary and any concurrent partners). In addition we will: 3. Evaluate the extent to which hypothesized mediating factors (e.g., relationship dynamics) explain the major outcomes and the extent to which the intervention affects these factors. PUBLIC HEALTH RELEVANCE: The proposed intervention will be conducted in Soweto, South Africa, an area that is significantly impacted by the HIV epidemic. This project aims to increase the liklihood that couples who participate in an intervention will learn their own HIV status and that of their partner via voluntary counseling and testing, as well as reduce sexual risk behavior which could place them at risk for HIV.