Childbearing Dynamics in Setting of High HIV Prevalence and Massive ART Rollout

描述(由申请人提供)：此申请是对NOT-OD-10-036的回应，“NIH宣布通过NIH基本行为和社会科学机会网络(OppNet)为艾滋病毒/艾滋病相关研究提供竞争性修订申请(R01、R03、R15、R21、R21/R33、R37)的资金。”这一竞争性修订建立在一个母项目的基础上，该项目审查了生育率变化与撒哈拉以南非洲扩大艾滋病毒检测和治疗之间的关系。对莫桑比克农村地区的一项临床调查和人种学数据进行的初步分析揭示了使用性保健和生殖保健设施的复杂动态。诊所工作人员报告说，妇女到不同的诊所接受不同类型的护理(计划生育咨询、产前护理和分娩、儿童疫苗接种、艾滋病毒检测和治疗)，妇女根据临床特点和她们所认为的血清状况选择诊所。距离和旅行时间是获得医疗保健的主要障碍，但对不同类型的医疗保健有不同的影响。值得注意的是，探索性空间数据分析显示了艾滋病毒检测经验和分娩诊所使用情况的不同分布。这些不可预见的结果表明，将艾滋病毒治疗和检测纳入妇幼保健诊所可能会对研究地区妇女使用避孕药具产生不同的影响。客户和诊所之间的地理距离和客户和提供者之间的社会距离可能会缓和一体化对避孕用具使用的影响。因此，这一修订建议将已婚妇女调查的信息与她们接受护理的设施联系起来，并对保健服务的使用情况进行空间分析，从而扩大到母项目之外。拟议的研究将结合来自母项目的现有地理和社会人口学数据，以(1)描述避孕用具的地理分布，并将其与其他卫生服务利用的分布进行比较；(2)分析避孕用具的决定因素，同时考虑到卫生保健设施的特点和艾滋病毒服务的引入的中介作用。空间数据和社会关系的空间方面将纳入拟议研究的所有阶段。所有工作将在亚利桑那州立大学由亚利桑那州立大学的教职员工和研究生进行；不建议进行额外的数据收集。 与公共卫生相关：拟议的研究将建立关于在艾滋病毒感染水平较高的农村地区使用避孕药具的科学知识，并迅速推出艾滋病毒检测和治疗服务。分析既衡量了获得医疗保健的地理位置，也衡量了有关社会背景的详细信息。研究结果将有助于卫生保健服务的适当安置，以及增进对卫生保健系统内的人际互动及其对健康结果的影响的了解。这些科学进步将有助于减少意外怀孕的努力。

DESCRIPTION (provided by applicant): This application is in response to NOT-OD-10-036, "NIH Announces the Availability of HIV/AIDS Funds for Competitive Revision Applications (R01, R03, R15, R21, R21/R33, R37) for HIV/AIDS-related Research through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet)." The competitive revision builds on a parent project examining the relationship between fertility change and the scaling-up of HIV testing and treatment in sub-Saharan Africa. Initial analysis of data from a clinic survey and ethnography in rural Mozambique revealed complex dynamics of use of health facilities for sexual and reproductive care. Clinic staff report that women attend different clinics for different types of care (family planning counseling, prenatal care and delivery, child vaccinations, HIV testing and treatment), with women's choice of clinic depending on both clinic characteristics and their perceived serostatus. Distance and travel time are major barriers to health care access, but impact different types of care differentially. Notably, exploratory spatial data analysis shows different distributions of HIV testing experience and use of clinics for childbirth. These unforeseen results suggest that the integration of HIV treatment and testing into maternal and child health clinics may have varying effects on contraceptive use among women in the study area. Geographic distance between clients and clinics and social distance between clients and providers may moderate the effects of integration on contraceptive use. This revision therefore proposes to expand beyond the parent project by linking information from a survey of married women to the facilities where they receive care and carrying out spatial analyses of the use of health services. The proposed research will combine existing geographic and sociodemographic data from the parent project to (1) describe the geographic distribution of contraceptive use and compare it to the distribution of other health service utilization; and (2) analyze the determinants of contraceptive use, taking into account the mediating effect of characteristics of health care facilities and introduction of HIV services. Spatial data and the spatial aspects of social relationships will be incorporated at all stages of the proposed research. All work will be carried out at Arizona State University by ASU faculty and graduate students; no additional data collection is proposed. PUBLIC HEALTH RELEVANCE: The proposed research will build scientific knowledge of the use of contraception in rural areas experiencing high levels of HIV infection and rapid rollout of HIV testing and treatment services. Analyses measure both geographic access to health care and detailed information on social context. The results will facilitate appropriate placement of health care services as well as increasing understanding of interpersonal interactions within health care systems and their impact on health outcomes. These scientific advances will contribute to efforts to reduce unintended pregnancies.