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

描述（由申请人提供）：这个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伴群体干预，特别是为马拉维的夫妇预防艾滋病毒。由于婚前或婚后无保护措施的性行为，已婚夫妇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，目前没有艾滋病毒预防干预措施专门针对夫妇的独特艾滋病毒预防需求。长期以来，性别不平等一直被认为是已婚夫妇，尤其是妻子预防艾滋病毒的障碍。然而，Pi最近的论文研究发现，在马拉维农村，夫妻的实际决策比丈夫总是占主导地位的简单剧本要复杂得多。夫妻使用以丈夫为主导的文化脚本，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、保持和谐和儿童福利。大多数夫妻采用丈夫主导、妻子主导和共同决策的混合模式。在第一阶段，这些广为接受的文化脚本和已被夫妇广泛使用的共同决策方式将被整合到马拉维已成功使用的现有同伴群体干预中。这种夫妇同伴小组干预将根据已婚夫妇的需要量身定制。还将制定针对夫妇具体结果的措施。在第二阶段。干预措施将进行试点。过程评价将记录干预的保真度、可接受性和可行性。对接受干预的已婚夫妇进行干预的短期影响的结果评估，将其与延迟对照组进行比较，在三个月时进行前测和后测。这项研究将在两个地区的四个低收入农村社区进行，一个是母系婚姻制度，一个是父系婚姻制度。假设将使用二元结果的比例二项式检验和连续变量的对比方差分析进行检验。任何基线差异都将被控制。我们将在基线时每组招募总共120对夫妇，在80%的保留率下，最终的样本将至少是每组96对夫妇。当alpha= 0.05时，该样本将提供足够的功率（0.80）来确定效应大小。连续变量为35（中等效应）。本研究以行为改变理论为基础，将文化适宜的夫妻决策文化脚本和共同决策风格与同伴群体干预相结合，是一项创新的科学进展。以社区为基础的参与性研究以及对个人和夫妻两级结果的检验也具有创新性。为已婚夫妇提供可接受和有效的艾滋病毒预防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.