The purpose of this K01 is to provide the candidate with the training and mentorship to become an independent behavioral scientist with expertise on couple-based approaches to optimize engagement in the HIV care continuum (CC) in sub-Saharan Africa. Research on the HIV CC in sub-Saharan Africa has largely focused on structural and individual-level barriers and facilitators, resulting in a weak understanding of factors at the relationship level. A central component of this K01 award is the conduct of research on dyadic aspects of engagement in the HIV CC among couples living with HIV. The proposed research will be situated in Malawi, a resource-poor country in SSA where 11% of adults are HIV-infected and an estimated 8,000 Malawians die each year from AIDS-related illness. The majority of new HIV infections occur within marriage or cohabitating unions. Despite the success of ART programs in Malawi, large numbers of HIV+ individuals who are eligible for ART and who have initiated ART continue to drop out of the HIV CC. Furthermore, as more HIV+ individuals access ART while healthier, there are growing concerns about long-term adherence to ART. Using a dyadic, mixed-methods study design, the specific aims of the research are: 1) to describe how the relationship context influences engagement in the HIV CC within Malawian couples; 2) to identify the relationship-level barriers and facilitators that affec engagement in the HIV CC; and, 3) to develop a preliminary intervention to optimize engagement in the HIV CC for Malawian couples.
For Aim 1, qualitative interviews will be conducted with 25 couples (50 individuals) with at least one partner who is either starting or already on ART.
For Aim 2, the qualitative findings will be analyzed to develop a survey for 200 ART patients and their primary partner. The survey will collect information on relationship dynamics and characteristics, treatment knowledge and beliefs, contextual factors related to HIV care and treatment, and measures of engagement in the HIV CC (e.g., attendance at clinic appointments, adherence to ART).Medical record data and hair specimens will also be collected from respondents on ART to supplement self-reported measures of engagement in care.
For Aim 3, 20 semi-structured interviews with community members and stakeholders, and 4 focus group discussions with couples will be conducted to inform the development of a relationship-focused intervention targeting optimal use of HIV care and treatment. Through this research plan, the candidate will gain practical training in four areas: (1) interpersonal theory to understand health behavior; (2) methodological skills to collect and analyze dyadic qualitative and quantitative data; (3) healthcare and clinical aspects of HIV/AIDS; and (4) behavioral intervention design and evaluation. An interdisciplinary team of mentors and scientific advisors will support the training and research plan through their combined expertise in couples-based research, dyadic data analysis, healthcare and medical management of HIV/AIDS, behavioral interventions for HIV/AIDS, and local knowledge of the Malawi context.

Public Health Relevance

As access to antiretroviral therapy (ART) rapidly increases across sub-Saharan Africa, optimal use of HIV care and treatment remains paramount to prevent transmission of HIV within ongoing sexual relationships: the setting where most new HIV infections occur. This research will conduct a dyadic investigation to better understand the influence of relationship factors such as communication, partner social support, and marital conflict on engagement in the HIV care continuum in Malawi. The findings will aid the development of a relationship-focused behavioral intervention to promote engagement in care for couples affected by HIV/AIDS.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01MH107331-04
Application #
9625165
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Senn, Theresa Elaine
Project Start
2016-02-05
Project End
2020-01-31
Budget Start
2019-02-01
Budget End
2020-01-31
Support Year
4
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Woolf-King, Sarah E; Conroy, Amy A; Fritz, Katherine et al. (2018) Alcohol use and relationship quality among South African couples. Subst Use Misuse :1-10
Tan, Judy Y; Campbell, Chadwick K; Tabrisky, Alyssa P et al. (2018) A Conceptual Model of Dyadic Coordination in HIV Care Engagement Among Couples of Black Men Who Have Sex with Men: A Qualitative Dyadic Analysis. AIDS Behav 22:2584-2592
Conroy, Amy A; McKenna, Stacey A; Comfort, Megan L et al. (2018) Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy. Soc Sci Med 214:110-117
Tan, Judy Y; Campbell, Chadwick K; Conroy, Amy A et al. (2018) Couple-Level Dynamics and Multilevel Challenges Among Black Men Who Have Sex with Men: A Framework of Dyadic HIV Care. AIDS Patient Care STDS 32:459-467
Conroy, Amy A; McKenna, Stacey A; Ruark, Allison (2018) Couple Interdependence Impacts Alcohol Use and Adherence to Antiretroviral Therapy in Malawi. AIDS Behav :
Conroy, Amy; Leddy, Anna; Johnson, Mallory et al. (2017) 'I told her this is your life': relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples. Cult Health Sex 19:1239-1253
Conroy, Amy A; McKenna, Stacey A; Leddy, Anna et al. (2017) ""If She is Drunk, I Don't Want Her to Take it"": Partner Beliefs and Influence on Use of Alcohol and Antiretroviral Therapy in South African Couples. AIDS Behav 21:1885-1891
Conroy, Amy A; Gamarel, Kristi E; Neilands, Torsten B et al. (2016) Partner Reports of HIV Viral Suppression Predict Sexual Behavior in Serodiscordant Male Couples. J Acquir Immune Defic Syndr 73:e31-3