Development of a digital intervention to address stigma among pregnant unmarried adolescents living with HIV

项目概要/摘要 肯尼亚是少数几个承受母婴传播高比率的国家之一 艾滋病毒感染率高、大量青少年感染艾滋病毒（ALHIV）以及青少年生育率上升。怀孕 与成年人相比，艾滋病毒携带者不太可能去产前保健诊所接受母婴传播预防 因此，儿童经母体感染艾滋病毒的比率很高。以前在15-19岁的肯尼亚ALHIV中的工作， 包括一些怀孕的人，发现耻辱，未公开的艾滋病毒状况和缺乏社会支持可能 是参与预防母婴传播服务的主要障碍。因此，消除披露和社会支持方面的障碍 可以减轻艾滋病毒和怀孕的交叉耻辱对健康结果的有害影响。虽然 混合，研究结果表明，使用短信（SMS）的移动健康干预措施可能会改善PMTCT 成果。然而，他们通过支持机制促进行为改变的能力有限， 技能发展。越来越多的证据凸显了数字干预作为重要工具的前景， 改善艾滋病毒防治成果和与父母的沟通。然而，数字干预措施，以解决影响 在怀孕的ALHIV中没有探索耻辱感。这项研究将建立在以前的工作，并借鉴 一个综合概念框架，以制定和评估未婚怀孕者的数字干预措施 ALHIV。干预措施将包括用于提醒目的的短信和基于网络的虚拟模拟， 要素和教学内容，以教育和培养与污名相关的技能。可接受的方法将 确定让家庭照顾者参与解决相互交叉的污名对儿童的有害影响， 怀孕的艾滋病病毒。家庭照顾者是一个重要的，但未得到充分重视和研究的社会来源， 支持未婚怀孕的艾滋病毒携带者。这些措施合在一起，预计将改善对预防母婴传播的参与 为怀孕的艾滋病毒携带者提供服务。本研究的具体目标是：（1）开发和评估数字干预 为15-19岁未婚怀孕的艾滋病毒携带者提高对耻辱及其后果的认识; 披露自我效能和技能;并促进招募家庭照顾者作为社会支持盟友， 提高对预防母婴传播服务的接受程度;（2）确定可接受的方法，提高对以下问题的认识： 消除家庭照料者的耻辱感，并提高他们的沟通技能和提供社会支助的能力。我们将 使用来自妊娠ALHIV患者单独访谈和妊娠ALHIV/护理者联合访谈的数据 制定初步干预规格和模型。然后我们将进行焦点小组讨论， 对样本材料的反馈意见，以完善材料和开发干预原型。我们将 然后进行试点，以评估原型的可接受性、可用性和初步功效。我们将 与照顾者进行焦点小组讨论，以确定让他们参与的可接受方法。数据将用于 最终确定怀孕ALHIV数字干预的内容和规格，并将提供框架 未来将对护理人员进行补充干预，这两项措施都将在更大的R34或R 01试验中进行测试。

Project Summary/Abstract Kenya is one of few countries burdened by a combination of high rates of mother-to-child transmission (MTCT) of HIV, large numbers of adolescents living with HIV (ALHIV), and elevated adolescent fertility rates. Pregnant ALHIV are less likely than adults to attend antenatal care clinics and to receive prevention of MTCT (PMTCT) services, thereby contributing to the high MTCT rate. Previous work among 15-19-year-old Kenyan ALHIV, including some who were pregnant, found that stigma, undisclosed HIV status, and lack of social support may be key barriers to engagement in PMTCT services. Thus, addressing barriers to disclosure and social support may mitigate harmful effects of the intersecting stigmas of HIV and pregnancy on health outcomes. Although mixed, study findings suggest that mHealth interventions that use text messaging (SMS) may improve PMTCT outcomes. They are, however, limited in their ability to facilitate behavior change via support mechanisms or skill development. Growing evidence highlights the promise of digital interventions as important tools for improving HIV outcomes and communication with parents. However, digital interventions to address the effects of stigma have not been explored among pregnant ALHIV. This study will build on previous work and draw on an integrated conceptual framework to develop and evaluate a digital intervention for pregnant unmarried ALHIV. The intervention will include SMS for reminder purposes and web-based virtual simulations, gamified elements, and didactic content to educate and build relevant stigma-related skills. Acceptable approaches will be identified to involve family caregivers in addressing the detrimental effects of the intersecting stigmas on pregnant ALHIV. Family caregivers are an important yet underappreciated and understudied source of social support for pregnant unmarried ALHIV. Together, these are expected to improve engagement in PMTCT services among pregnant ALHIV. The study specific aims are to: (1) Develop and evaluate a digital intervention for pregnant unmarried ALHIV aged 15-19 to increase awareness of stigma and its consequences; improve disclosure self-efficacy and skills; and facilitate enlistment of family caregivers as social support allies to enhance uptake of PMTCT services; and (2) Identify acceptable approaches to increase awareness about stigma and enhance skills in communication and provision of social support among family caregivers. We will use data from individual interviews with pregnant ALHIV and joint interviews with pregnant ALHIV/caregiver dyads to develop initial intervention specifications and mock-ups. We will then conduct focus group to obtain feedback on sample materials in order to refine the materials and develop an intervention prototype. We will then conduct a pilot to evaluate acceptability, usability, and preliminary efficacy of the prototype. We will conduct focus groups with caregivers to identify acceptable approaches to involve them. Data will be used to finalize content and specifications of the digital intervention for pregnant ALHIV and will provide the framework for a future complementary intervention for caregivers, which will both be tested in a larger R34 or R01 trial.