Peer groups for healthy pregnancy & HIV prevention for young Malawian women

健康怀孕的同伴群体

• 批准号: 8055890
• 负责人: KATHLEEN F NORR
• 金额: $ 45.05万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-10 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8055890
• 关键词: AIDS prevention; Adult; Advocate; African; Age; Alcohol or Other Drugs use; Assertiveness; Attitude; Behavior; Behavioral; Child; Collaborations; Communities; Community Health Systems; Community Workers; Computer Assisted; Conceptions; Contraceptive methods; Control Groups; Country; Data; Data Collection; Decision Making; Development; Diffuse; Evaluation; Family Planning; Fertility; Funding; Future; Gender Issues; HIV; HIV Infections; Habits; Health; Health behavior; Health education; Health system; Human immunodeficiency virus test; Individual; Intention; Intervention; Interview; Knowledge; Logistics; Malawi; Measures; Mediating; Mediation; Methods; Modeling; Outcome; Peer Group; Planned Pregnancy; Population; Pregnancy; Prevalence; Prevention; Prevention education; Primary Health Care; Publishing; Randomized; Reporting; Reproductive Health; Research; Resources; Rural; Rural Community; Sampling; Schools; Self Efficacy; Services; Sexuality; Surveys; Symptoms; Testing; Theoretical model; Training; Treatment Efficacy; UNFPA; United Nations; Unplanned pregnancy; Woman; World Health Organization; base; comparison group; condoms; cost effectiveness; design; diet and exercise; efficacy testing; girls; group intervention; group support; health care model; high risk; improved; innovation; peer; post intervention; pregnancy prevention; prevent; programs; public health relevance; rehearsal; reproductive; role model; safer sex; sexually active; skills; unintended pregnancy

DESCRIPTION (provided by applicant): Maintaining optimal reproductive health in the context of high HIV prevalence poses a serious dilemma for young rural Malawian women ages 15-20 who make behavioral choices regarding their sexuality and fertility that have health implications for them and their future children. Optimal reproductive health requires these preconceptual behaviors: safer sex (abstaining or using condoms) to prevent STIs, including HIV infection; treatment for STIs; maintaining good health habits such as diet, exercise and avoiding substance use; using an effective family planning method to prevent unintended pregnancy; and having an HIV test periodically and with the partner when conception is intended. However, no programs in Malawi offer a comprehensive, integrated approach to promoting optimal reproductive health. Also, we found no published programs that integrate issues of conceiving and HIV/STIs prevention. To fill this gap, we developed the Mzanga intervention, a community-based culturally grounded peer group intervention led by two trained community young women assisted by a local health worker. The Mzanga intervention integrates behavioral change models, contextual tailoring including developmental and gender issues, and WHO primary health care principles. We will test the efficacy of this intervention using a longitudinal, two-group comparison design with a delayed control group. Eighteen geographically separate rural communities will be stratified by size and distance from the main paved road and then randomly assigned to the intervention and delayed control conditions. After attrition, a final sample of 345 in the intervention and in the control groups will provide adequate power to detect medium effects. We hypothesize that at 9 and 15 months post-baseline (6 and 12 months post-intervention), compared to the control group, the intervention group will have more positive mediating and behavioral outcomes. Mediating outcome variables include knowledge, attitudes, perceived norms, self-efficacy, and intention for each of the behavioral outcomes. Behavioral outcomes are abstaining or consistently using condoms except when pregnancy is intended; seeking prompt treatment within two weeks at the health center for STI symptoms; maintaining a nutritious diet, exercising regularly, and avoiding substance use; using an effective family planning method except when pregnancy is intended, and having an HIV test periodically and with the partner when conception is intended. The intervention occurs across 9 waves, with 4 peer groups per wave. Following baseline assessment, the intervention group will receive the 8 session intervention. Outcomes will be evaluated at 9 and 15 months post-baseline. All evaluation will be conducted using an audio computer-assisted self-interview. The delayed control group will receive the intervention after the 15 month evaluation. Data will be analyzed using logistic and OLS regression. If this innovative intervention is effective, this research will make a major contribution toward promoting optimal reproductive health, including HIV prevention, for women and their babies in Malawi and throughout the African region. PUBLIC HEALTH RELEVANCE: Young rural Malawian women ages 15-20 are at high risk of HIV infection, unplanned pregnancy, and passing HIV to their babies, yet few programs exist that help them deal with these issues. The proposed research will develop and test a peer led intervention to integrate HIV prevention with pregnancy planning. This research will make a major contribution toward promoting pregnancy planning and HIV prevention for women and their babies in Malawi and throughout the African region.

描述（由申请人提供）：在艾滋病毒高流行率的背景下，保持最佳生殖健康对15-20岁的马拉维农村年轻妇女构成了严重的困境，她们在性行为和生育方面做出的行为选择对她们及其未来的孩子产生了健康影响。最佳的生殖健康需要这些观念前的行为：更安全的性行为（禁欲或使用避孕套），以预防性传播感染，包括艾滋病毒感染;性传播感染治疗;保持良好的卫生习惯，如饮食、锻炼和避免使用药物;使用有效的计划生育方法，以防止意外怀孕;定期进行艾滋病毒检测，并在打算怀孕时与伴侣一起进行。然而，马拉维没有任何方案提供全面、综合的办法来促进最佳生殖健康。此外，我们没有发现任何出版的方案，整合怀孕和艾滋病毒/性传播感染预防问题。为了填补这一空白，我们开发了Mzanga干预，这是一种以社区为基础的基于文化的同龄人群体干预，由两名受过培训的社区年轻妇女领导，并由当地卫生工作者协助。姆赞加干预措施整合了行为改变模式、包括发展和性别问题在内的背景调整以及世卫组织初级卫生保健原则。我们将使用纵向、两组比较设计和延迟对照组来测试这种干预的有效性。18个地理上独立的农村社区将根据规模和与主要铺砌道路的距离进行分层，然后随机分配到干预和延迟控制条件。在损耗之后，干预组和对照组中的345个最终样本将提供足够的把握度来检测中等效应。我们假设，在基线后9个月和15个月（干预后6个月和12个月），与对照组相比，干预组将有更多的积极中介和行为结果。中介结果变量包括知识，态度，感知规范，自我效能感和意图的每一个行为结果。行为结果是：除非打算怀孕，否则不使用避孕套或坚持使用避孕套;在两周内到卫生中心寻求性传播感染症状的及时治疗;保持营养饮食，定期锻炼，避免使用药物;除非打算怀孕，否则使用有效的计划生育方法，并在打算怀孕时定期与伴侣一起进行艾滋病毒检测。干预发生在9个波中，每个波有4个同伴群体。基线评估后，干预组将接受8次干预。将在基线后9个月和15个月评价结局。所有评价都将使用计算机辅助的自我访谈进行。延迟对照组将在15个月评估后接受干预。将使用logistic和OLS回归分析数据。如果这种创新的干预措施有效，这项研究将为促进马拉维和整个非洲地区妇女及其婴儿的最佳生殖健康，包括艾滋病毒预防做出重大贡献。 公共卫生相关性：马拉维农村15-20岁的年轻妇女感染艾滋病毒、意外怀孕和将艾滋病毒传给婴儿的风险很高，但帮助她们处理这些问题的方案很少。拟议的研究将开发和测试一种同伴主导的干预措施，将艾滋病毒预防与怀孕计划结合起来。这项研究将为促进马拉维和整个非洲地区的妇女及其婴儿的怀孕计划和艾滋病毒预防做出重大贡献。