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

Mobile WACh Empower：为感染艾滋病毒的女性提供生殖生活规划的移动解决方案

• 批准号: 10636940
• 负责人: Alison L Drake
• 金额: $ 67.2万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636940
• 关键词: Address; Africa South of the Sahara; Behavior; Behavioral; Caring; Climate; Clinic; Communication; Complex; Conceptions; Consolidated Framework for Implementation Research; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Decision Making; Drug Interactions; Effectiveness of Interventions; Enrollment; Ensure; Environment; Evaluation; Face; Family Planning; Fertility; Focus Groups; Goals; HIV; Health; Health Personnel; Health Technology; Health system; Healthcare Systems; Intervention; Justice; Kenya; Life; Maternal and Child Health; Maternal-Child Health Services; Measures; Methods; Modeling; Mother-to-child HIV transmission; Motion; Motivation; Outcome; Pharmaceutical Preparations; Planned Pregnancy; Population; Pregnancy; Prevention; Provider; Randomized, Controlled Trials; Readiness; Reproductive Health; Reproductive Health Services; Resource-limited setting; Resources; Rights; Risk; STI prevention; Self Efficacy; Services; Site; Surveys; Testing; Time; Training; Treatment Protocols; Viral; Woman; acceptability and feasibility; antiretroviral therapy; arm; care providers; cost; cost effective; cost effectiveness; cost estimate; design; economic evaluation; economic impact; empowerment; experience; future implementation; health care service; health economics; health goals; healthy pregnancy; implementation barriers; implementation science; improved; internalized stigma; intervention cost; mHealth; mathematical model; meeting abstracts; meetings; microcosting; novel; patient level intervention; postpartum contraception; pregnancy prevention; prevent; programs; reproductive; secondary outcome; service delivery; side effect; skills; standard of care; texting support; theories; tool; treatment arm; two way texting; unintended pregnancy

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.

项目总结/摘要 满足感染艾滋病毒的妇女的生殖健康需求对帮助妇女预防艾滋病毒感染至关重要。 意外怀孕、安全怀孕和消除母婴艾滋病毒传播。生殖 对于WLWH来说，生活规划是复杂的，他们面临着选择抗逆转录病毒治疗的决定 以及药物与避孕方法相互作用的可能性、安全受孕计划和性传播感染预防。 虽然WLWH中计划生育（FP）的使用率很高，但停止FP的妇女很常见， 希望预防怀孕，是未满足的FP需求和随后的意外风险的重要驱动因素 怀孕和不利的母婴健康结果。撒哈拉以南非洲地区的许多项目 计划生育服务纳入常规艾滋病毒护理，但艾滋病毒护理提供者在实施这些模式方面面临挑战 护理。艾滋病毒护理提供者可能没有能力确保WLWH获得高质量的、基于权利的生殖保健服务。 由于缺乏时间、培训、资源和技能，健康咨询和服务不足。关于整合FP的先前研究 将艾滋病毒护理服务纳入艾滋病毒护理的工作中，始终提到执行方面的挑战。移动的医疗技术可以提供低成本的 增加咨询服务、加强卫生保健系统和缓解艾滋病毒需求的成本解决方案 提供商我们假设，提供全面的咨询和双向短信沟通， 将1）改善艾滋病毒和生殖保健综合服务的提供，2）减少避孕药具的使用， 中止率，3）可接受和可行的实施，以及4）具有成本效益并有助于 预防母婴传播的努力。我们将采用独特的双向短信平台（移动的WACh）， 自动批量短信和对话与卫生保健提供者为新的人口，新 环境，以及长期影响的新成果。将定制移动的WACh平台， 为WLWH提供持续的生殖生活规划咨询。我们将在一个 在肯尼亚10个设施（每个设施330人）接受艾滋病毒护理的妇女中进行的随机对照试验。 本研究拟评估心理咨询、短信沟通干预、移动的WACh 在生殖健康成果方面增强权能。在目标1中，我们将确定移动的WACh的效果 授权对FP停药、双重方法使用和2年内未满足的FP需求进行干预。在目标2中， 我们将评估在真实的环境下实施移动的WACh Empower的可接受性、可行性和可扩展性， 在焦点小组讨论中，从WLWH和提供商的角度来看世界环境。在目标3中，我们将构建 一个数学模型来衡量健康和经济影响的移动的WACh授权，包括成本- 每次怀孕和避免母婴传播的干预效果。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关键差距，并有可能使 为实现普及计划生育和消除母婴传播的全球目标作出了重大贡献。