mHealth Intervention to Increase Uptake of Contraception and PrEP Among Female University Students in Zambia

项目总结/摘要 艾滋病毒感染和意外怀孕在少女中非常普遍，是改变生活的事件， 低收入和中等收入国家的年轻女性。由于一些生物、社会和结构因素， 撒哈拉以南非洲的少女和年轻妇女仍然是最易感染艾滋病毒的亚群体 感染此外，少女和年轻妇女的怀孕大多发生在低生育率和低生育率的家庭。 中等收入国家中，撒哈拉以南非洲的发病率最高。在赞比亚，女子大学 学生是被忽视的艾滋病毒感染和意外怀孕的高风险亚群体。口服前 暴露预防（PrEP）和现代避孕是关键的生物医学预防工具， 事实证明，撒哈拉以南非洲青年妇女的接受具有挑战性。根据初步研究，我们 建议设计一种针对高危女性的新型同伴导航器PrEP/避孕移动健康干预 赞比亚大学的学生。将通过平板电脑平台促进同行导航员干预 评估艾滋病毒和意外怀孕风险，提供教育和信息，将高危年轻妇女与 性和生殖服务，评估对同伴支持的偏好，跟踪卫生服务的使用情况， 通过定期沟通，为PrEP和避孕措施的采用和坚持提供持续支持。 使用由综合行为和移动健康理论指导的混合方法分阶段方法，我们将首先 使用以人为本的设计和定性方法调整现有应用程序（PEBRA），以创建新的平板电脑- 基于应用程序，作为同行导航员的平台，以促进和跟踪PrEP和避孕的使用， 高危女学生（目标1，R21阶段）。在利益相关者评估了几次迭代之后，我们 将在一个小型的前瞻性单组试验中测试应用程序和同行导航干预包，收集数据 应用程序的功能和同行导航员干预的可接受性/适当性（目标2，R21 阶段）。在完善应用程序和干预包后，我们将彻底测试mHealth干预 通过一项单中心混合1型有效性-实施随机对照试验，以1）确定 增加PrEP使用和现代避孕药具使用的干预措施的有效性，2）建立基础 行为机制，以及3）评估与实施相关的因素，这些因素将提高 实施、维持和扩大移动健康干预措施（目标3，R33阶段）。如果被证明有效，同行- 导航移动健康干预将提供一个可扩展的模式，以填补艾滋病毒预防和 在艾滋病毒高流行率的低收入和中等收入国家环境中，青年妇女的生殖健康。

Project Summary/Abstract HIV infection and unintended pregnancy are highly prevalent, life-altering events among adolescent girls and young women in low- and middle-income countries. Due to a number of biological, social, and structural factors, adolescent girls and young women in sub-Saharan Africa remain the sub-population most susceptible to HIV infection. Further, the majority of pregnancies among adolescent girls and young women occur in low- and middle-income countries with the highest rates found in sub-Saharan Africa. In Zambia, female university students are a neglected, high-risk sub-population for both HIV infection and unintended pregnancy. Oral pre- exposure prophylaxis (PrEP) and modern contraception are key biomedical prevention tools but increasing the uptake among young women in sub-Saharan Africa has proven challenging. Based on preliminary research, we propose to design a novel peer navigator PrEP/contraception mhealth intervention targeting high-risk female students at the University of Zambia. The peer-navigator intervention will be facilitated by a tablet-based platform to assess HIV and unintended pregnancy risk, provide education and information, link high-risk young women to sexual and reproductive services, assess preferences for peer support, track the use of health services, and provide ongoing support for PrEP and contraception uptake and persistence through regular communication. Using a mixed methods phased approach guided by integrated behavioral and mHealth theories, we will first adapt an existing app (PEBRA) using Human-Centered Design and qualitative methods to create a new tablet- based app to serve as a platform for peer navigators to promote and track PrEP and contraception use among high-risk female students (Aim 1, R21 phase). After several iterations have been evaluated by stakeholders, we will test the app and peer-navigator intervention package in a small prospective single-arm trial, collecting data on the functionality of the app and the acceptably/appropriateness of the peer-navigator intervention (Aim 2, R21 phase). After refining the app and intervention package, we will then thoroughly test the mHealth intervention through a single-site hybrid type 1 effectiveness-implementation randomized controlled trial to 1) determine the effectiveness of the intervention to increase PrEP use and modern contraceptive use, 2) establish underlying behavioral mechanisms, and 3) evaluate implementation-related factors that will enhance the likelihood for the mHealth intervention to be implemented, sustained, and scaled (Aim 3, R33 phase). If proven effective, the peer- navigator mHealth intervention will provide a scalable model to fill-in persistent gaps in HIV prevention and reproductive health among young women in high HIV prevalence low- and middle-income country settings.