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: 10673744
• 负责人: Karen Marie Hampanda
• 金额: $ 17.95万
• 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/10673744
• 关键词: AIDS prevention; Adolescent; Adult; Africa South of the Sahara; African; Authorization documentation; Awareness; Behavioral; Behavioral Mechanisms; Biological Factors; Caring; Cause of Death; Clinic; Communication; Contraceptive Agents; Contraceptive Availability; Contraceptive Usage; Contraceptive methods; Counseling; Country; Data; Education; Effectiveness of Interventions; Ensure; Event; Face; Female; Female Adolescents; Future; Government; HIV; HIV Infections; Health; Hybrids; Intention; Intervention; 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; Predisposition; Pregnancy; Pregnancy Complications; Prevention; Public Health; Qualitative Methods; Quality of life; Recommendation; Reproductive Health; Reproductive Health Services; Research; Risk; Running; Self Efficacy; Services; Sexual Health; Site; Students; Surveys; Tablets; Testing; Universities; Visit; Zambia; age group; aged; arm; authority; 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; service delivery; sexual health intervention; social; social factors; social stigma; structural determinants; 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.

项目概要/摘要 艾滋病毒感染和意外怀孕是青春期女孩和青少年中非常普遍的、改变生活的事件。 低收入和中等收入国家的年轻女性。由于许多生物、社会和结构因素， 撒哈拉以南非洲地区的少女和年轻妇女仍然是最容易感染艾滋病毒的人群 感染。此外，大多数青春期女孩和年轻妇女的怀孕发生在低收入和低收入国家。 撒哈拉以南非洲地区发病率最高的中等收入国家。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危人群。口服预 暴露预防 (PrEP) 和现代避孕方法是关键的生物医学预防工具，但增加了 事实证明，撒哈拉以南非洲地区年轻女性的接受度具有挑战性。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 PrEP/避孕移动健康干预措施 赞比亚大学的学生。基于平板电脑的平台将促进同行导航干预 评估艾滋病毒和意外怀孕风险，提供教育和信息，将高危年轻女性与 性和生殖服务，评估同伴支持的偏好，跟踪卫生服务的使用情况，以及 通过定期沟通，为 PrEP 以及避孕措施的采用和坚持提供持续支持。 使用以综合行为和移动健康理论为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）来创建新的平板电脑 - 基于应用程序作为同行导航者的平台，以促进和跟踪 PrEP 和避孕措施的使用情况 高风险女学生（目标 1，R21 阶段）。经过利益相关者的多次迭代评估后，我们 将在小型前瞻性单臂试验中测试应用程序和同行导航干预包，收集数据 关于应用程序的功能以及同行导航干预的可接受性/适当性（目标 2，R21 阶段）。完善应用程序和干预包后，我们将彻底测试移动医疗干预 通过单点混合 1 型有效性实施随机对照试验来 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的可能性 实施、持续和扩大移动健康干预措施（目标 3，R33 阶段）。如果证明有效，同行 navigator mHealth 干预措施将提供一个可扩展的模型，以填补艾滋病毒预防和治疗方面持续存在的空白。 艾滋病毒高流行的低收入和中等收入国家年轻妇女的生殖健康。