Eighty percent of the world's HIV infections are in sub-Saharan Africa. In Lusaka, the capital of Zambia, 85% of pregnant women are married and 47% are in. couples with at least one HIV+ partner (26% concordant positive, 21% discordant). It will be years before short course antivirals are widely implemented and many children who escape infection will be left orphaned. There are 360,000 AIDS orphans in Zambia, a country of 9 million, and 35, 000 HIV+ women deliver each year. Prevention of unplanned pregnancy in couples with HIV can reduce pediatric AIDS, HIV orphans, and the family consequences of parental illness and death. We have previously HIV tested and counseled 10,000 couples from Lusaka for our ongoing NIH funded studies of heterosexual HIV transmission. In a pilot randomized controlled trial of family planning promotion with 251 couples, we observed a marked increase in injectable and oral hormonal contraceptive uptake. The attrition rate was high, however, and compliance with oral contraception was poor. Although incident pregnancy was lower with the intervention, the magnitude of the impact was far less than anticipated. Effective, user-- independent methods such as the IUD and Norplant had lower attrition rates but they are unfamiliar to providers and clients and few women elected to use them. In this study, we will enroll 5000 concordant HIV+ and discordant couples in a randomized factorial trial of two interventions to reduce unplanned pregnancies. The first intervention will promote more effective contraception by placing user independent methods first in the educational message hierarchy and employing positive message framing. The second intervention will help couples plan for the consequences of their illness and death. This will include assisting husband and wife to work together and prepare a will, choose a guardian, and make a financial plan. By focusing on the cost of educating existing children and on the need to plan for their future care, we will encourage couples to reflect on the implications of future childbearing. We hypothesize that this will result in a decision to limit fertility. A standard family planning service will be compared with either or both interventions with respect to impact on incident pregnancy, contraceptive choice and pattern of use, psychosocial and behavioral variables, and future planning actions. Cost- effectiveness will be determined with methods developed jointly by experts in the fields of HIV therapy in Africa and contraception.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD040125-01A1
Application #
6348449
Study Section
AIDS and Related Research 8 (AARR)
Program Officer
Newcomer, Susan
Project Start
2001-06-01
Project End
2006-05-31
Budget Start
2001-06-01
Budget End
2002-05-31
Support Year
1
Fiscal Year
2001
Total Cost
$839,339
Indirect Cost
Name
University of Alabama Birmingham
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
004514360
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Wall, Kristin M; Inambao, Mubiana; Kilembe, William et al. (2018) HIV testing and counselling couples together for affordable HIV prevention in Africa. Int J Epidemiol :
Haddad, Lisa B; Wall, Kristin M; Kilembe, William et al. (2018) Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition. AIDS 32:595-604
Joseph Davey, Dvora Leah; Wall, Kristin M; Kilembe, William et al. (2018) Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia. PLoS One 13:e0189869
Joseph Davey, Dvora L; Wall, Kristin M; Kilembe, William et al. (2017) HIV Incidence and Predictors of HIV Acquisition From an Outside Partner in Serodiscordant Couples in Lusaka, Zambia. J Acquir Immune Defic Syndr 76:123-131
Wall, Kristin M; Kilembe, William; Vwalika, Bellington et al. (2017) Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994-2012. Int J Epidemiol 46:1593-1606
Wall, Kristin M; Kilembe, William; Vwalika, Bellington et al. (2017) Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples. Sex Transm Infect 93:259-266
Joseph Davey, Dvora; Kilembe, William; Wall, Kristin M et al. (2017) Risky Sex and HIV Acquisition Among HIV Serodiscordant Couples in Zambia, 2002-2012: What Does Alcohol Have To Do With It? AIDS Behav 21:1892-1903
Karita, Etienne; Nsanzimana, Sabin; Ndagije, Felix et al. (2016) Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice. J Acquir Immune Defic Syndr 73:e51-e58
Wall, Kristin M; Kilembe, William; Haddad, Lisa et al. (2016) Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women. J Acquir Immune Defic Syndr 71:345-52
Wall, Kristin M; Kilembe, William; Vwalika, Bellington et al. (2016) Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012. J Infect Dis 214:1063-71

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