Effects of a prosocial intervention among sellers of HIV and reproductive health supplies on young women’s health

艾滋病毒和生殖健康用品销售者的亲社会干预对年轻女性健康的影响

• 批准号: 10509329
• 负责人: Jenny Xin Liu
• 金额: $ 8.08万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10509329
• 关键词: AIDS prevention; Africa South of the Sahara; Age; Area; Automobile Driving; Award; Baseline Surveys; Behavior; Businesses; Caring; Characteristics; Cluster randomized trial; Community Health; Community Services; Complement; Contraceptive Agents; Contraceptive Distributions; Contraceptive methods; Diagnostic Reagent Kits; Effectiveness; Enrollment; Ensure; Equipment and supply inventories; Face; Failure; Feedback; Female Adolescents; Future; Goals; Gold; HIV; Health; Health system; Heterogeneity; Human immunodeficiency virus test; Image; Intervention; Literature; Measures; Methods; Motivation; Outcome; Parents; Performance; Persons; Pharmaceutical Preparations; Phase; Population Dynamics; Positioning Attribute; Preventive; Preventive Health Services; Price; Private Sector; Privatization; Provider; Public Health; Randomized; Randomized Controlled Trials; Reporting; Reproductive Health; Reproductive Health Services; Research Infrastructure; Research Priority; Resources; Role; Sales; Sampling; Service provision; Services; Sexual Health; Side; Surveys; System; Tanzania; Testing; Time; Women' s Health; Work; arm; base; behavior change; behavioral economics; consumer demand; cost effective; design; experience; girls; innovation; insight; intervention program; novel; peer; pilot test; point of care; pregnancy prevention; prevention service; primary endpoint; primary outcome; programs; secondary endpoint; secondary outcome; self testing; service uptake; social; theories; trend; unintended pregnancy; uptake; willingness; young woman

SUMMARY In sub-Saharan Africa, adolescent girls and young women (AGYW; ages 15-24) face the dual threats of unintended pregnancy and HIV, but struggle to access critical preventive health services, such as HIV testing and contraception. As discreet and convenient access points, private sector drug shops have the potential to amplify access among AGYW, as demonstrated by our R34 pilot of our Malkia Klabu (“Queen Club”) intervention in Tanzania, a loyalty program that creates AGYW-friendly drug shops where AGYW can access contraception and HIV prevention services. While our pilot showed great potential for Malkia Kalbu to increase AGYW demand for such services at drug shops, shopkeepers were reluctant to continue service provision to AGYW beyond the study period. AGYW products were perceived to yield low profits, despite shopkeepers recognizing the benefit of increased AGYW patronage and expressing desires to support broader community health in their role as first point of care. Thus, private providers need additional motivation to independently support service provision to AGYW, even when consumer demand is high. Building on our planned cluster-randomized control trial (CRCT) our Malkia Klabu AGYW program in Tanzania (R01MH12451601), we proposed to pilot-test 2 strategies that bolster shopkeepers’ motivations to distribute AGYW SRH products: (1) privately giving AGYW customer feedback to shopkeepers to leverage prosocial motivation, and; (2) publicly giving AGYW customer feedback with peer comparisons to leverage social image motivations. Based on insights from behavioral economics (BE) and the mixed-methods results from our pilot, our novel interventions aim to harness shopkeepers’ intrinsic prosocial motivation towards AGYW and tendency to compare themselves with their peers. We hypothesize that providing customer feedback from AGYW to socially-motivated shopkeepers will encourage distribution of contraception and HIVST, especially when feedback is publicly displayed. To that end, we have designed a mixed-methods R03 study that leverages the research infrastructure and implementation from our parent R01 CRCT. Our proposed study will assess the effect of these strategies on shopkeepers’ distribution of HIVST and contraceptives to AGYW (Aim 1), and use mixed-methods to understand shopkeepers’ experiences and assess to what extent treatment mechanisms through prosocial motivation and social image theory drive behavior change (Aim 2). Specifically, we will cross-randomize the initial condition (i.e., No Feedback, Private Feedback, and Public Feedback) across the parent R01 CRCT’s 120 enrolled drug shops, with progressive phase-in of additional intervention conditions for each group over 18 months. If feasible and with preliminary evidence of effectiveness, we will develop our enhanced Malkia Klabu program for a future R01 sustainability study. Our study’s focus on increasing AGYW’s access to contraception matches the Population Dynamics Branch’s research priorities.

总结 在撒哈拉以南非洲，少女和年轻妇女（15-24岁）面临着双重威胁， 意外怀孕和艾滋病毒，但难以获得关键的预防性卫生服务，如艾滋病毒检测 和避孕。作为谨慎和方便的入口点，私营部门的药店有可能 扩大AGYW之间的访问，正如我们的Malkia Klabu（“女王俱乐部”）的R34试点所证明的那样 在坦桑尼亚的干预，一个忠诚计划，创造AGYW友好的药店，AGYW可以访问 避孕和艾滋病毒预防服务。虽然我们的飞行员显示出巨大的潜力，Malkia Kalbu增加 AGYW要求药店提供这种服务，店主不愿意继续提供服务， AGYW在研究期间之后。AGYW产品被认为利润低，尽管店主 认识到增加AGYW赞助的好处，并表示希望支持更广泛的社区 健康作为第一护理点。因此，私营提供者需要更多的动力， 即使在消费者需求很高的情况下，也要支持向青年妇女协会提供服务。 基于我们计划的分组随机对照试验（CRCT），我们在坦桑尼亚的Malkia Klabu AGYW项目 （R 01 MH 12451601），我们提出了试点测试2个战略，支持店主的动机，分发 AGYW SRH产品：（1）私下向店主提供AGYW客户反馈，以利用亲社会 动机;（2）公开给予AGYW客户反馈，并进行同行比较，以利用社会形象 动机基于行为经济学（BE）的见解和我们试点的混合方法结果， 我们的新干预措施旨在利用店主对AGYW的内在亲社会动机， 倾向于将自己与同龄人比较。我们假设，提供客户反馈， 向有社会动机的店主提供AGYW将鼓励分发避孕药具和艾滋病毒/艾滋病防治服务， 当反馈被公开展示时。 为此，我们设计了一项混合方法R 03研究，该研究利用了研究基础设施， 从我们的父R 01 CRCT实现。我们建议的研究将评估这些策略对 * 店主向女青年协会分发艾滋病毒/艾滋病防治和避孕药具（目标1），并采用混合方法， 了解店主的经验，并评估在何种程度上通过亲社会的治疗机制， 动机和社会形象理论驱动行为改变（目标2）。具体来说，我们将交叉随机化 初始条件（即，无反馈、私人反馈和公共反馈） 120家登记的药店，对18岁以上的每个群体逐步逐步采用额外的干预条件 个月如果可行并且有初步的有效性证据，我们将开发我们的增强型Malkia Klabu 未来R 01可持续性研究的计划。我们的研究重点是增加AGYW获得避孕药具的机会 符合人口动态分支的研究重点。