Improving the Reproductive Health of Families

博茨瓦纳的青少年面临着非同寻常的生殖健康挑战。少女怀孕迫使女孩离开 学校毕业后，很少人恢复学业。博茨瓦纳的艾滋病毒流行率位居世界第二， 发病率在15-19岁时迅速上升，到30-34岁时达到40.2%的高峰。性传播感染盛行，尽管 提供免费医疗服务。在现在被禁止的乡村启蒙学校提供的传统性教育，是没有的 更长的时间可用，父母在家庭内讨论生殖健康时感到不舒服。在较早的R34中 在社区咨询委员会和青少年咨询小组的指导下，我们进行了形成性访谈， 评估拟议措施的心理测量学充分性，并调整和评估可行性和 对青少年及其父母的干预措施的可接受性。我们现在建议进行三臂随机对照试验 试验涉及500个家庭，其中一半是男性，一半是女性，年龄在13-18岁之间。臂1(N=200)将接收 家长干预《家庭重要2！》(FM2！)他们的青少年将参加“作为一个更安全的青少年生活” (最后)。在手臂2(N=200)中，父母收到FM2！只有在六个月后，他们的青少年才会得到最后 使我们能够单独评估家长计划的影响，并在青少年也处于 参与了干预。ARM 3(N=100)，即比较ARM，将是当前广泛交付的计划 博茨瓦纳。每个青少年和父母都将在基线上用英语或茨瓦纳语完成ACASI评估， 干预后，为期6个月和12个月的家庭沟通、育儿实践、性知识 发展和性行为。青年还将完成评估对以下问题的态度的心理社会措施 避孕套，性安全的感知障碍，对交易性行为的态度，对性别暴力的接受，以及 自我效能。淋病、衣原体、单纯疱疹病毒2型(HSV2)和人类免疫缺陷病毒(HIV) 将在基线时进行测试，并对青少年进行12个月的随访。一次试点试验证实了招募的可行性 父母和青少年的父母(照顾者)/青少年的双亲和保留率均超过95%。在试点试验期间 结果表明，这些干预措施改善了家庭沟通，提高了儿童管理技能， 性发育知识，对避孕的态度；对代际交易的容忍度降低 性暴力和性别暴力；并在干预臂中降低父母和青少年的性危险行为。在……里面 此外，在参与试点干预时禁欲的年轻人似乎更多地推迟了首次性行为 成功地超过了对比臂。这项研究涉及博茨瓦纳当前国家战略中的最高优先事项 计划。如果结果提供了有效的有力证据，教育部、卫生部、青年部和文化部 国家艾滋病协调机构和总统办公室已承诺将其传播到 博茨瓦纳。

Adolescents in Botswana face extraordinary reproductive health challenges. Teen pregnancy forces girls to leave school after which few resume their education. Botswana has the second highest HIV prevalence in the world, with incidence increasing rapidly at ages 15-19, peaking at 40.2% prevalence by ages 30-34. STIs are prevalent despite the availability of free health care. Traditional sex education, provided in now banned village initiation schools, is no longer available and parents are uncomfortable discussing reproductive health within the family. In an earlier R34 award, guided by a Community Advisory Board and Adolescent Advisory Group, we conducted formative interviews, assessed the psychometric adequacy of the proposed measures, and adapted and assessed the feasibility and acceptability of interventions for youth and their parents. We now propose to conduct a 3-arm randomized controlled trial with 500 families, ½ with a male and ½ with a female adolescent age 13-18. Arm 1 (N = 200) will receive the parent intervention “Families Matter 2!” (FM2!) and their adolescent will participate in “Living as a Safer Teen” (LAST). In Arm 2 (N = 200), parents receive FM2! Only and six months later their adolescents will receive LAST allowing us to assess the impact of the parent program alone and potential boost in outcomes when adolescents are also engaged in intervention. Arm 3 (N = 100), the comparison arm, will be the current, widely-delivered program in Botswana. Each adolescent and parent dyad will complete ACASI assessments in English or Setswana at baseline, post-intervention, 6- and 12-month follow-ups on family communication, parenting practices, knowledge of sexual development, and sexual behavior. Youth will also complete psychosocial measures assessing attitudes toward condoms, perceived barriers to sexual safety, attitudes toward transactional sex, acceptance of gender violence, and self-efficacy. Gonorrhea, chlamydia, herpes simplex virus type 2 (HSV2), and human immunodeficiency virus (HIV) will be tested at baseline and 12-month follow-up for adolescents. A pilot trial affirmed the feasibility of recruiting parent(caretaker)/adolescent dyads and retention exceeded 95% for both parents and adolescents. While the pilot trial was underpowered, results suggest that the interventions improved family communication, child management skills, knowledge of sexual development, attitudes toward contraception; lowered tolerance for intergenerational transactional sex and gender violence; and lowered sexual risk behavior of both parents and adolescents in the intervention arm. In addition, youths who were abstinent upon entering the pilot intervention appear to have delayed sexual debut more successfully than the comparison arm. This study addresses the highest priority in Botswana’s current national strategic plan. If the results provide strong evidence of effectiveness, the Ministries of Education, Health, Youth & Culture, National AIDS Coordinating Agency, and the Office of the President have committed to its dissemination throughout Botswana.