Reproductive health decisions and HIV infection risk

描述（由申请人提供）：在高流行地区，成熟的艾滋病毒流行的特点是，在稳定的关系中，艾滋病毒感染率显著不一致，这代表着相当大的艾滋病毒传播风险。这种流行病主要影响到处于生育高峰期的妇女，她们可能不知道自己的艾滋病毒状况或使用避孕套。在艾滋病毒高流行地区资源有限的环境中，故意生育可能使异性恋夫妇面临感染艾滋病毒的风险，而这些地区的社会非常重视生育。我们提出了一项基于社区的前瞻性队列研究，该研究将为异性恋活跃夫妇提供基于家庭的艾滋病毒咨询和检测，并获得肯尼亚西部Nyando地区男性和女性的生殖和性健康数据以及怀孕和艾滋病毒发病率。随机选择的HIV感染者(n？960)，协负(n的子集？960)和和谐阳性(n？480对夫妇将被跟踪。目的1。在2年内，每6个月进行一次快速艾滋病毒检测，确定并比较打算怀孕的艾滋病毒不一致夫妇与不打算怀孕的夫妇之间的艾滋病毒发病率。目标2。描述和比较队列中的性行为、避孕、避孕套使用、夫妻层面的行为和因素以及社会文化规范，使用快速尿妊娠试验，以及来自二组中每个成员的音频计算机辅助自我访谈，每6个月一次，持续2年。目标3。发展生殖决策过程如何影响艾滋病毒传播风险的理论社会行为模型。该模型将使用目标1和目标2的数据，以及通过在基线和第18个月进行的双组访谈（n=30）和12个焦点小组讨论（艾滋病毒阴性男性、艾滋病毒阴性女性、艾滋病毒阳性男性、艾滋病毒阳性女性）收集的定性数据来开发。我们将使用结构方程模型将理论模型元素应用于队列数据，以评估其在预测HIV事件和怀孕方面的价值。将在肯尼亚召开一次政策会议，讨论研究结果。这项研究将有助于设计干预措施，以减少在资源有限的情况下艾滋病毒的横向和纵向传播。

DESCRIPTION (provided by applicant): Mature HIV epidemics in high prevalence regions are characterized by significant HIV discordance rates in stable relationships, representing considerable HIV transmission risk. The pandemic primarily affects those in peak years of childbearing, who may not be aware of their HIV status or use condoms. Intentional childbearing may place heterosexual couples at risk of HIV infection in resource-limited settings with high HIV prevalence areas where society places great value on having children. We propose a community-based prospective cohort study that will offer home-based HIV counseling and testing to heterosexually active couples and obtain reproductive and sexual health data and pregnancy and HIV incidence from men and women in Nyando district, western Kenya. A randomly-selected cohort of HIV discordant (n?960), concordant-negative (subset of n?960) and concordant-positive (n?480) couples will be followed. Aim 1. Determine and compare HIV incidence among HIV-discordant couples who intend pregnancy, versus those who do not intend to become pregnant, using rapid HIV assays every 6 months for 2 years. Aim 2. Describe and compare sexual behaviors, contraception, condom use, couple-level behaviors and factors, and sociocultural norms in the cohort, using rapid urine pregnancy tests, and audio computer-assisted self interviews from each member of the dyad, every 6 months for 2 years. Aim 3. Develop a theoretical sociobehavioral model of how reproductive decision-making processes influence the risk of HIV transmission. This model will be developed using Aims 1 and 2 data as well as qualitative data collected via dyad interviews (n=30) and 12 focus group discussions (among HIV-negative males, HIV-negative females, HIV-positive males, HIV-positive females), conducted at baseline and at month 18. We will apply the theoretical model elements to the cohort data using structural equation modeling to assess its value in predicting incident HIV and pregnancy. A policy meeting will be held in Kenya to discuss study findings. This study will contribute significantly to design of interventions to reduce horizontal and vertical HIV transmission in resource-limited settings.