Development of a digital intervention to address stigma among pregnant unmarried adolescents living with HIV

开发数字干预措施以解决感染艾滋病毒的未婚怀孕青少年的耻辱问题

• 批准号: 10684537
• 负责人: Winfred K Luseno
• 金额: $ 14.54万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10684537
• 关键词: 19 year old; Address; Adolescent; Adult; Ally; Awareness; Caregivers; Caring; Cellular Phone; Characteristics; Clinic; Communication; Counseling; Country; Data; Data Analyses; Development; Disclosure; Effectiveness; Elements; Family Caregiver; Family member; Feedback; Fertility Rates; Focus Groups; Fright; Future; Goals; Guidelines; HIV; Health; Health Promotion; Human immunodeficiency virus test; Individual; Infant; Intervention; Interview; Joints; Kenya; Measures; Mother-to-child HIV transmission; Online Systems; Outcome; Output; Parents; Participant; Perception; Pregnancy; Pregnancy in Adolescence; Pregnant Women; Prevalence; Prevention; Reaction; Research; Role; Rural; Sampling; Self Disclosure; Self Efficacy; Services; Social support; Source; Symptoms; Testing; Text Messaging; Unmarried; Vertical Disease Transmission; Visit; Vulnerable Populations; Woman; Work; Writing; Youth; aged; antenatal care; antiretroviral therapy; behavior change; caregiver interventions; cultural competence; digital; digital intervention; experience; family caregiving; improved; mHealth; multidisciplinary; novel; pregnant; pregnant teen; prevent; prevention service; prototype; reproductive outcome; skill acquisition; skills; social stigma; teenage fertility; tool; treatment adherence; uptake; usability; virtual reality simulation; young mother

Project Summary/Abstract Kenya is one of few countries burdened by a combination of high rates of mother-to-child transmission (MTCT) of HIV, large numbers of adolescents living with HIV (ALHIV), and elevated adolescent fertility rates. Pregnant ALHIV are less likely than adults to attend antenatal care clinics and to receive prevention of MTCT (PMTCT) services, thereby contributing to the high MTCT rate. Previous work among 15-19-year-old Kenyan ALHIV, including some who were pregnant, found that stigma, undisclosed HIV status, and lack of social support may be key barriers to engagement in PMTCT services. Thus, addressing barriers to disclosure and social support may mitigate harmful effects of the intersecting stigmas of HIV and pregnancy on health outcomes. Although mixed, study findings suggest that mHealth interventions that use text messaging (SMS) may improve PMTCT outcomes. They are, however, limited in their ability to facilitate behavior change via support mechanisms or skill development. Growing evidence highlights the promise of digital interventions as important tools for improving HIV outcomes and communication with parents. However, digital interventions to address the effects of stigma have not been explored among pregnant ALHIV. This study will build on previous work and draw on an integrated conceptual framework to develop and evaluate a digital intervention for pregnant unmarried ALHIV. The intervention will include SMS for reminder purposes and web-based virtual simulations, gamified elements, and didactic content to educate and build relevant stigma-related skills. Acceptable approaches will be identified to involve family caregivers in addressing the detrimental effects of the intersecting stigmas on pregnant ALHIV. Family caregivers are an important yet underappreciated and understudied source of social support for pregnant unmarried ALHIV. Together, these are expected to improve engagement in PMTCT services among pregnant ALHIV. The study specific aims are to: (1) Develop and evaluate a digital intervention for pregnant unmarried ALHIV aged 15-19 to increase awareness of stigma and its consequences; improve disclosure self-efficacy and skills; and facilitate enlistment of family caregivers as social support allies to enhance uptake of PMTCT services; and (2) Identify acceptable approaches to increase awareness about stigma and enhance skills in communication and provision of social support among family caregivers. We will use data from individual interviews with pregnant ALHIV and joint interviews with pregnant ALHIV/caregiver dyads to develop initial intervention specifications and mock-ups. We will then conduct focus group to obtain feedback on sample materials in order to refine the materials and develop an intervention prototype. We will then conduct a pilot to evaluate acceptability, usability, and preliminary efficacy of the prototype. We will conduct focus groups with caregivers to identify acceptable approaches to involve them. Data will be used to finalize content and specifications of the digital intervention for pregnant ALHIV and will provide the framework for a future complementary intervention for caregivers, which will both be tested in a larger R34 or R01 trial.

项目摘要/摘要 肯尼亚是少数因高妇女传播率（MTCT）组合而负担的国家之一 艾滋病毒，大量艾滋病毒（ALHIV）的青少年和青少年生育率升高。孕 ALHIV比成年人参加产前护理诊所并接受MTCT（PMTCT）的可能性少。 服务，从而导致高度MTCT率。 15-19岁的肯尼亚·阿尔希夫（Kenyan Alhiv）的先前工作， 包括一些怀孕的人，发现污名，未公开的艾滋病毒状况以及缺乏社会支持 成为参与PMTCT服务的关键障碍。因此，解决披露和社会支持的障碍 可以减轻艾滋病毒和妊娠污名对健康结果的有害影响。虽然 混合研究结果表明，使用文本消息传递（SMS）的MHealth干预措施可能会改善PMTCT 结果。但是，他们通过支持机制或 技能发展。越来越多的证据凸显了数字干预作为重要工具的承诺 改善艾滋病毒的结果和与父母的沟通。但是，数字干预措施以解决效果 在怀孕的Alhiv中尚未探索污名。这项研究将以先前的工作为基础，并借鉴 一个综合概念框架，用于开发和评估怀孕未婚的数字干预 alhiv。干预措施将包括用于提醒目的的SMS和基于Web的虚拟模拟， 元素和教学内容，以教育和建立相关的污名相关技能。可以接受的方法将 被确定可以让家庭护理人员解决相交对污名的有害影响 怀孕的alhiv。家庭护理人员是一个重要但被低估的社会来源 支持怀孕的未婚Alhiv。预计这些将改善PMTCT的参与度 怀孕Alhiv的服务。该研究的具体目的是：（1）开发和评估数字干预 为了使15-19岁的怀孕未婚ALHIV提高人们对污名的认识及其后果；提升 披露自我效能和技能；并促进入伍家庭护理人员作为社会支持盟友 增强PMTCT服务的吸收； （2）确定可接受的方法以提高人们对 污名并增强了家庭护理人员之间的沟通和社会支持的技能。我们将 使用怀孕Alhiv的个人访谈中的数据，并与怀孕的Alhiv/Caregiver进行联合访谈 开发初始干预规格和模型的二元组。然后，我们将进行焦点小组以获得 样品材料的反馈，以完善材料并开发干预原型。我们将 然后进行试点以评估原型的可接受性，可用性和初步功效。我们将 与护理人员一起进行焦点小组，以确定可接受的方法使他们参与其中。数据将用于 最终确定孕妇ALHIV数字干预的内容和规格，并将提供框架 对于未来的护理人员进行互补干预，这两者都将在较大的R34或R01试验中进行测试。