Mobile WACh Empower: Mobile solutions to empower reproductive life planning for women living with HIV

项目摘要/摘要 满足艾滋病毒携带者妇女的生殖健康需求对于帮助妇女预防 意外怀孕、安全受孕和消除母婴传播(母婴传播)。生殖 对于WLWH来说，生活规划是复杂的，他们面临着做出抗逆转录病毒治疗选择的决定 以及药物与避孕方法、安全受孕规划和性传播感染预防之间相互作用的可能性。 虽然计划生育(FP)的使用率在WLWH中很高，但在以下女性中停止使用FP是很常见的 意愿怀孕预防，是未得到满足的计划生育需求和随后的意外风险的重要驱动因素 怀孕和不良的孕产妇和儿童健康后果。撒哈拉以南非洲的许多项目整合了 将计划生育服务提供给常规的艾滋病毒护理，但艾滋病毒护理提供者在实施这些模式时面临挑战 关爱。艾滋病毒护理提供者可能装备不足，无法确保WLWH获得高质量的、基于权利的生殖 缺乏时间、培训、资源和技能的健康咨询和服务。整合FP的前期研究 艾滋病毒护理方面的服务始终提到实施方面的挑战。移动医疗技术可能会提供低成本 成本解决方案，以增加咨询服务，加强医疗保健系统，并缓解对艾滋病毒的需求 供应商。我们假设提供全面的咨询和双向短信交流， 将1)改善艾滋病毒和生殖保健综合服务的提供，2)减少避孕 停机率，3)可接受和可行的实施，以及4)成本效益和贡献 预防母婴传播的努力。我们将采用一个独特的双向短信平台(Mobile Wach)，它结合了 自动群发短信并与医疗保健提供商对话，面向新的人群、新的 环境，以及产生长期影响的新成果。Mobile Wach平台将进行定制，以 为妇幼保健院提供持续的生殖生活规划咨询。我们将测试联合干预在一个 在肯尼亚10个机构接受艾滋病毒护理的妇女中进行的整群随机对照试验(每个机构330个)。 我们建议评估咨询和短信交流干预的效果，Mobile Wach 增强生殖健康成果方面的能力。在目标1中，我们将确定移动Wach的效果 加强对FP停用、双重方法使用和2年以上FP需求未得到满足的干预。在目标2中， 我们将评估在真实环境下实施移动通信授权的可接受性、可行性和可扩展性。 世界设置，从WLWH和提供者的角度在焦点小组讨论中。在目标3中，我们将构建 一个数学模型来衡量移动电话授权对健康和经济的影响，包括成本- 避免了每孕期干预和母婴传播的效果。这项试验将评估一种新的干预措施 解决在提供综合生殖健康和艾滋病毒护理方面的一个重大差距，并有可能使 对普及计划生育和消除母婴传播的全球目标作出重大贡献。

PROJECT SUMMARY/ ABSTRACT Meeting reproductive health needs of women living with HIV (WLWH) is essential to help women prevent unintended pregnancies, safely conceive, and eliminate mother-to-child HIV transmission (MTCT). Reproductive life planning is complex for WLWH, who are faced with making decisions about antiretroviral treatment selections and potential for drug interactions with contraceptive methods, planning for safe conception, and STI prevention. While family planning (FP) use is high among WLWH, discontinuation of FP is common among women who desire pregnancy prevention, and is an important driver of unmet need for FP and subsequent risk of unintended pregnancy and adverse maternal and child health outcomes. Many programs in sub-Saharan Africa integrate FP service delivery into routine HIV care, but HIV care providers face challenges with implementing these models of care. HIV care providers may be ill equipped to ensure WLWH receive high-quality, rights’ based reproductive health counseling and services due to lack time, training, resources, and skills. Prior studies on integrating FP services into HIV care consistently cite implementation challenges. Mobile health technology may provide a low cost solution to augment counseling services, strengthen health care systems, and alleviate demands on HIV providers. We hypothesize that providing comprehensive counseling and two-way SMS communication, will 1) improve delivery of integrated HIV and reproductive health care services, 2) reduce contraceptive discontinuation rates, 3) be acceptable and feasible to implement, and 4) be cost-effective and contribute to prevention MTCT efforts. We will adapt a unique two-way SMS platform (Mobile WACh) that combines automated bulk SMS messaging and dialogue with a health care provider for a new population, new environment, and new outcomes for long-term impact. The Mobile WACh platform will be customized to provide continuous reproductive life planning counseling for WLWH. We will test the combined intervention in a cluster randomized controlled trial among women receiving HIV care at 10 facilities in Kenya (330 per facility). We propose to evaluate the effect of the counseling and SMS communication intervention, Mobile WACh Empower, on reproductive health outcomes. In Aim 1, we will determine the effect of the Mobile WACh Empower intervention on FP discontinuation, dual method use, and unmet need for FP over 2 years. In Aim 2, we will evaluate acceptability, feasibility, and scalability of implementing Mobile WACh Empower under real- world settings, from both WLWH and provider perspectives in focus group discussions. In Aim 3, we will construct a mathematical model to measure health and economic impacts of Mobile WACh Empower, including cost- effectiveness of the intervention per pregnancy and MTCT averted. This trial will evaluate a novel intervention to address a crucial gap in provision of integrated reproductive health and HIV care, and has the potential to make a significant contribution to global goals of universal access to FP and elimination of MTCT.