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

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，她们根据自己的性取向和生育能力做出行为选择 这对他们和他们未来的孩子都有健康影响。最佳生殖健康需要以下几点 怀孕前行为：安全的性行为(禁欲或使用避孕套)，以防止性传播感染，包括艾滋病毒感染； 治疗性传播感染；保持良好的健康习惯，如饮食、锻炼和避免使用物质；使用 有效的计划生育方法，防止意外怀孕；定期进行艾滋病毒检测和 在怀孕的时候和伴侣在一起。然而，马拉维没有一个项目提供全面的、 促进最佳生殖健康的综合办法。此外，我们没有发现任何已发布的程序 将怀孕和艾滋病毒/性传播感染预防问题结合起来。为了填补这一空白，我们开发了Mzanga干预， 由两名训练有素的社区年轻女性领导的以社区为基础、以文化为基础的同伴小组干预 由当地一名卫生工作者协助。Mzanga干预集成了行为变化模型、上下文 量身定做，包括发展和性别问题，以及世卫组织初级保健原则。我们将测试 采用纵向、两组对照设计与延迟控制组进行干预的有效性。 18个地理上不同的农村社区将根据大小和与主要铺面的距离进行分层 然后随机分配给道路干预和延时控制条件。在磨合之后，决赛 干预组和对照组中的345个样本将提供足够的能力来检测介质 效果。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 每一种行为结果。行为结果是禁欲或持续使用避孕套，除非 怀孕时；在两周内到性传播感染健康中心寻求及时治疗 症状；保持有营养的饮食，经常锻炼，避免使用物质；使用有效的 计划生育方法，除非打算怀孕，并定期进行艾滋病毒检测 受孕时的伴侣。干预跨越9个波，每个波4个同龄人组。 在基线评估后，干预组将接受第8次干预。结果将是 在基线后9个月和15个月进行评估。所有评估将使用音频计算机辅助进行 自我采访。延迟对照组在15个月评估后接受干预。数据将 用Logistic回归和OLS回归进行分析。如果这种创新的干预是有效的，这项研究将 为促进妇女最佳生殖健康作出重大贡献，包括预防艾滋病毒 以及他们在马拉维和整个非洲地区的婴儿。

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.