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

项目摘要/摘要 肯尼亚是少数几个母婴传播率高的国家之一。 艾滋病毒的增加、大量的青少年艾滋病毒携带者(ALHIV)以及青少年生育率上升。怀孕了 与成年人相比，ALHIV患者不太可能去产前护理诊所和接受母婴传播预防(PMTCT) 服务，从而助长了母婴传播的高比率。之前在15-19岁的肯尼亚ALHIV患者中进行的研究， 包括一些怀孕的人，发现耻辱，未披露的艾滋病毒状况，以及缺乏社会支持可能 成为参与防止母婴传播服务的主要障碍。因此，消除披露和社会支持的障碍 可以减轻艾滋病毒和怀孕这一相互交织的污名对健康结果的有害影响。虽然 混合的研究结果表明，使用短信(SMS)的mHealth干预可能会改善母婴传播 结果。然而，他们通过支持机制促进行为改变的能力有限，或者 技能发展。越来越多的证据突显了数字干预作为 改善艾滋病毒结果和与父母的沟通。然而，解决这些影响的数字干预措施 在怀孕的ALHIV患者中，尚未探索耻辱的原因。本研究将在前人工作的基础上，借鉴 开发和评估未婚妊娠数字化干预的综合概念框架 爱滋病。干预将包括用于提醒目的的短信和基于网络的虚拟模拟，游戏化 要素和说教内容，以教育和建立与污名相关的相关技能。可接受的方法将 确定让家庭照顾者参与解决相互交叉的耻辱对 怀孕的艾滋病毒感染者。家庭照顾者是一个重要的但未得到重视和研究的社会来源 支持怀孕未婚的ALHIV。总而言之，这些都有望提高防止母婴传播的参与度 在怀孕的ALHIV患者中提供服务。本研究的具体目标是：(1)开发和评估数字干预 对于15-19岁未婚怀孕的ALHIV病毒感染者，提高对耻辱及其后果的认识；改善 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 加强对防止母婴传播服务的接受；和(2)确定可接受的方法，以提高对以下问题的认识 提高家庭照顾者的沟通和提供社会支持的技能。我们会 使用与孕妇ALHIV单独访谈和与孕妇ALHIV/照顾者联合访谈的数据 开发初始干预规范和模型的DYADS。然后我们会进行焦点小组，以获得 对样本材料进行反馈，以提炼材料并开发干预原型。我们会 然后进行试点，评估原型的可接受性、可用性和初步效果。我们会 与照顾者一起组织焦点小组，以确定可接受的方法，让他们参与进来。数据将用于 最终确定孕妇ALHIV数字干预的内容和规范，并将提供框架 未来对照顾者的补充干预，这两项都将在更大的R34或R01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.