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

移动医疗干预措施提高赞比亚女大学生对避孕和 PrEP 的采用率

• 批准号: 10536340
• 负责人: Karen Marie Hampanda
• 金额: $ 18.82万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536340
• 关键词: AIDS prevention; Adolescent; Adult; Africa South of the Sahara; African; Awareness; Behavioral; Behavioral Mechanisms; Biological; Caring; Cause of Death; Clinic; Communication; Contraceptive Agents; Contraceptive Availability; Contraceptive Usage; Contraceptive methods; Counseling; Data; Education; Effectiveness of Interventions; Ensure; Event; Face; Female; Female Adolescents; Future; Government; HIV; HIV Infections; Health; Human; Hybrids; Intention; Intervention; Intervention Studies; Interview; Investments; Knowledge; Lesotho; Level of Evidence; Life; Life Change Events; Link; Low Prevalence; Mediation; Methods; Mobile Health Application; Modeling; Modernization; Notification; Oral; Outcome; Outcome Study; Participant; Pathway interactions; Perception; Performance; Phase; Population; Pregnancy; Pregnancy Complications; Prevention; Public Health; Qualitative Methods; Quality of life; Recommendation; Reproductive Health; Reproductive Health Services; Research; Risk; Running; Sampling; Self Efficacy; Services; Sexual Health; Site; Students; Surveys; Tablets; Testing; Universities; Visit; Zambia; age group; aged; arm; authority; base; design; effectiveness evaluation; effectiveness-implementation RCT; experience; follow-up; health belief; health service use; high risk; high-risk adolescents; human centered design; implementation determinants; implementation evaluation; improved; innovation; low and middle-income countries; mHealth; member; mortality; navigator intervention; neglect; novel; peer; peer support; pre-exposure prophylaxis; preference; prevent; primary outcome; programs; prospective; randomized trial; reproductive; reproductive health intervention; reproductive outcome; scale up; secondary outcome; social; social stigma; social structure; theories; tool; unintended pregnancy; university student; uptake; young woman

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.

项目摘要/摘要 艾滋病毒感染和意外怀孕是青春期女孩中高度普遍，改变人生的事件 低收入和中等收入国家的年轻妇女。由于许多生物学，社会和结构性因素， 撒哈拉以南非洲的青春期女孩和年轻妇女仍然是最容易受到艾滋病毒的亚人群 感染。此外，青春期女孩和年轻妇女中的大多数怀孕发生在低和 在撒哈拉以南非洲的中等收入国家的比率最高。在赞比亚，女大学 学生是艾滋病毒感染和意外怀孕的被忽视的高风险亚人群。口服前 预防暴露（PREP）和现代避孕是关键的生物医学预防工具，但增加了 撒哈拉以南非洲年轻妇女的吸收已被证明具有挑战性。根据初步研究，我们 建议设计一种新型的同伴导航器准备/避孕MHealth干预措施，针对高危女性 赞比亚大学的学生。基于平板电脑的平台将促进同伴 - 武器干预 为了评估艾滋病毒和意外怀孕风险，提供教育和信息，将高风险的年轻妇女与 性和生殖服务，评估同伴支持的偏好，跟踪健康服务的使用以及 通过常规沟通提供持续的支持和避孕的吸收和持久性。 使用由综合行为和MHe​​alth理论指导的混合方法分阶段的方法，我们将首先 使用以人为本的设计和定性方法适应现有应用程序（PEBRA），以创建新的平板电脑 基于同行导航器的平台，以促进和跟踪准备和避孕的使用 高风险女学生（AIM 1，R21阶段）。在经过几次迭代经过评估后，我们 将在一项小型前瞻性单臂试验中测试应用程序和同伴 - 纳维加器干预软件包，收集数据 关于应用程序的功能以及同伴 - 武器干预的可接受/适当性（AIM 2，R21 阶段）。完善应用程序和干预套件后，我们将彻底测试MHealth干预措施 通过单位点混合1型有效性实施随机对照试验到1）确定 干预措施增加准备使用和现代避孕药的有效性，2）建立基础 行为机制和3）评估与实施相关的因素，以增强可能性的可能性 MHealth干预将要实施，维持和缩放（AIM 3，R33阶段）。如果被证明有效，同行 Navigator MHealth干预将提供可扩展的模型，以填补预防HIV和 高艾滋病毒患病率低收入和中等收入国家环境的年轻妇女的生殖健康。