Assessing providers' reproductive counseling practice for South Africans with HIV

描述(由申请人提供)：背景-在稳定的、血清不一致的夫妇中传播艾滋病毒可能占撒哈拉以南非洲新的艾滋病毒感染的60%。许多艾滋病病毒携带者的夫妻都想要孩子，但目前的预防计划并不能满足生育的愿望。生物医学预防方面的进步为选择怀孕的人创造了极大地降低艾滋病毒传播风险的机会。拟议的工作重点是讨论医护人员(HCW)和他们的艾滋病毒阳性患者之间的生育意愿，这是任何生殖咨询干预的关键第一步。 关于卫生工作者和患者讨论生育计划的频率或效率，以及成功讨论的障碍，人们知之甚少。方法-我们将进行深入访谈，以探索卫生工作者(顾问、护士、医生)在南非德班附近的公共部门诊所为艾滋病毒携带者男性和女性提供生殖咨询的观点和做法。我们将采访从这些诊所寻求治疗的HIV+男性和女性，以探索他们在生殖咨询方面的经验。定性数据和患者-提供者交流的概念框架将成为调查工具；将对120名卫生工作者进行调查，以评估艾滋病毒阳性患者生育意愿评估的频率和预测因素。创新--在合意怀孕的情况下尽量减少艾滋病毒在不和谐夫妇中的传播，是减少艾滋病毒横向和纵向传播的公共卫生优先事项。CAPRISA004、iPrEX、HPTN 052、Partners PrEP和CDC TDF2研究的数据表明，对HIV不和谐夫妇的预防干预将包括局部或系统性抗逆转录病毒药物。为了设计有效的药物行为干预措施，有必要更好地了解卫生工作者目前对受孕咨询的看法和做法。我们的专家团队在行为科学(邦斯伯格，萨夫伦)、艾滋病毒-生殖健康(哈里森，SMIT)、干预开发(PSAROS，萨夫伦)和患者-提供者沟通(威尔逊)方面将为马修斯博士提供支持，马修斯博士是一名初级调查员，在这一背景下开展研究以了解艾滋病毒携带者的围绝风险行为和降低围绝风险的策略方面有着出色的记录。意义-行为策略、包皮环切术、抗逆转录病毒治疗和暴露前抗逆转录病毒预防为艾滋病毒感染不和谐的夫妇创造了实现生育目标的机会，同时将围产期艾滋病毒传播风险降至最低。拟议的工作将导致对患者和卫生工作者经历的细致入微的了解，并将为干预措施的设计提供信息，以优化卫生工作者对生育目标的评估和未来生殖咨询干预措施的实施。

DESCRIPTION (provided by applicant): Background- HIV transmission in stable, serodiscordant couples may account for up to 60% of new HIV infections in sub-Saharan Africa. Many HIV-discordant couples' desire children, yet current prevention programs do not accommodate fertility desire. Advances in biomedical prevention create opportunities to dramatically reduce the risk of HIV transmission for individuals who choose to conceive. The proposed work focuses on discussions of fertility intention between healthcare workers (HCWs) and their HIV-positive patients, a critical first step to any reproductive counseling intervention. Little is known about how often or effectively HCWs and patients discuss fertility plans or the barriers to successful discussions. Approach- We will conduct in-depth interviews to explore views and practices of HCWs (counselors, nurses, doctors) providing reproductive counseling to HIV+ men and women in public sector clinics near Durban, South Africa. We will interview HIV+ men and women seeking care from these clinics to explore their experiences with reproductive counseling. Qualitative data and a conceptual framework for patient-provider communication will inform a survey instrument; 120 HCWs will be surveyed to assess frequency and predictors of fertility intention assessment with HIV+ patients. Innovation- Minimizing HIV transmission in the context of desired conception among HIV- discordant couples is a public health priority to reduce horizontal and vertical HIV transmission. Data from CAPRISA004, iPrEX, HPTN 052, Partners PrEP, and CDC TDF2 studies demonstrate that a prevention intervention for HIV-discordant couples will include topical or systemic ARVs. A better understanding of HCWs' current views and practices of conception counseling is necessary in order to design effective pharmaco-behavioral interventions. Our team of experts in behavioral science (Bangsberg, Safren), HIV-reproductive health (Harrison, Smit), intervention development (Psaros, Safren), and patient-provider communication (Wilson) will support Dr. Matthews, a junior investigator with an excellent track record of carrying out research in this setting to understand periconception risk behavior and strategies for periconception risk reduction for HIV-discordant couples. Significance- Behavioral strategies, circumcision, antiretroviral therapy, and pre-exposure antiretroviral prophylaxis create opportunities for HIV-discordant couples to realize fertility goals while minimizing periconception HIV transmission risk. The proposed work will result in a nuanced understanding of the experiences of patients and HCWs and will inform design of interventions to optimize HCW assessment of fertility goals and implementation of future reproductive counseling interventions.