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

说明(申请人提供)：南非15-49岁成年人艾滋病毒感染率为18%，女性产前门诊就诊者感染率为30%(联合国艾滋病规划署，2007年)，表明继续需要有效预防艾滋病毒。此外，撒哈拉以南非洲最近的研究发现，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，以增加居住在南非索韦托的夫妇的艾滋病毒检测。拟议的以理论为基础的、文化上适当的干预包括六次会议(一次混合性别小组、一次单一性别小组和四次夫妻咨询会议)。使用350对异性伴侣的随机对照试验设计，我们将检验这一假设，即与单一的混合性别小组会议相比，拟议的干预将改善沟通、亲密和信任，这将导致更好地就与艾滋病毒风险和检测有关的问题进行沟通，这反过来将提高夫妇谈判更安全的性行为的能力，并增加他们对艾滋病毒VCT的参与。这项干预是基于PI通过NIH颁发的K08奖项进行的初步研究，该研究是在索韦托进行的。拟议的研究利用了PI建立的基础设施和协作关系，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以理论为基础和以文化为基础的夫妇干预措施的有效性，结果如下：1.艾滋病毒检测率。2.艾滋病毒的性行为危险行为(与主要或同时发生的性伴侣)。此外，我们还将：3.评估假设的中介因素(例如，关系动力学)在多大程度上解释了主要结果，以及干预在多大程度上影响了这些因素。 与公共卫生相关：拟议的干预措施将在南非索韦托进行，该地区受到艾滋病毒疫情的严重影响。该项目旨在增加参与干预的夫妇通过自愿咨询和检测了解自己和伴侣的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.