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

在艾滋病毒高流行率的情况下保持最佳生殖健康， 马拉维农村15-20岁的年轻妇女，她们在性和生育方面做出行为选择 对他们和他们未来的孩子有健康影响。最佳生殖健康需要这些 概念前行为：安全性行为（禁欲或使用避孕套），以预防性传播感染，包括艾滋病毒感染; 性传播感染的治疗;保持良好的健康习惯，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， 在怀孕的时候和伴侣在一起。然而，马拉维没有任何方案提供全面、 采取综合办法促进最佳生殖健康。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，我们开发了姆赞加干预， 由两名受过培训的社区年轻妇女领导的基于社区文化的同龄人小组干预 由当地卫生工作者协助。Mzanga干预整合了行为变化模型， 定制，包括发展和性别问题以及世卫组织初级卫生保健原则。我们将测试 使用纵向、两组比较设计和延迟控制组来评估这种干预的有效性。 18个地理上独立的农村社区将根据规模和距离主要铺设的 然后随机分配到干预和延迟控制条件下。经过磨合， 干预组和对照组的345份样本将提供足够的把握度来检测培养基 方面的影响.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，干预组的中介效果和行为效果更好。 中介结果变量包括知识、态度、知觉规范、自我效能感和 每一个行为结果。行为结果是禁欲或坚持使用避孕套， 打算怀孕时;在两周内到性病保健中心寻求及时治疗 症状;保持营养饮食，定期锻炼，避免使用物质;使用有效的 计划生育方法，除非打算怀孕，定期进行艾滋病毒检测， 当你打算怀孕的时候。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。成果将 在基线后9个月和15个月进行评价。所有评估将使用计算机辅助音频系统进行。 自我采访延迟对照组将在15个月评估后接受干预。数据将 使用logistic和OLS回归进行分析。如果这种创新的干预措施是有效的，这项研究将 * 为促进妇女的最佳生殖健康，包括预防艾滋病毒作出重大贡献 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.