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

项目概要/摘要 满足艾滋病毒感染者 (WLWH) 妇女的生殖健康需求对于帮助妇女预防艾滋病毒感染至关重要 意外怀孕、安全受孕并消除艾滋病毒母婴传播 (MTCT)。生殖 对于 WLWH 来说，人生规划很复杂，他们面临着抗逆转录病毒治疗选择的决定 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。 虽然计划生育 (FP) 在 WLWH 中使用率较高，但在以下妇女中停止 FP 也很常见 希望预防怀孕，并且是 FP 需求未得到满足以及随后出现意外风险的重要驱动因素 怀孕和不良的孕产妇和儿童健康结果。撒哈拉以南非洲的许多计划都整合了 将计划生育服务纳入常规艾滋病毒护理中，但艾滋病毒护理提供者在实施这些模式时面临挑战 的照顾。艾滋病毒护理提供者可能没有能力确保 WLWH 获得高质量、基于权利的生殖服务 由于缺乏时间、培训、资源和技能而无法提供健康咨询和服务。整合 FP 的先前研究 艾滋病毒护理服务不断提到实施方面的挑战。移动医疗技术可能会提供低 增加咨询服务、加强医疗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) 改善综合艾滋病毒和生殖保健服务的提供，2) 减少避孕药具 停药率，3) 可接受且实施可行，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（Mobile WACh），该平台结合了 为新人群、新人群自动发送短信并与医疗保健提供者对话 环境和长期影响的新成果。 Mobile WACh 平台将定制为 为 WLWH 提供持续的生殖生活规划咨询。我们将测试联合干预 在肯尼亚 10 个设施（每个设施 330 名）接受艾滋病毒护理的妇女中进行的整群随机对照试验。 我们建议评估咨询和短信沟通干预、Mobile WACh 的效果 赋予生殖健康成果权力。在目标 1 中，我们将确定 Mobile WACh 的效果 对 FP 终止、双重方法使用以及 2 年内未满足的 FP 需求进行干预。在目标 2 中， 我们将评估在实际情况下实施 Mobile 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 和提供商的角度来了解世界环境。在目标 3 中，我们将构建 用于衡量 Mobile WACh Empower 的健康和经济影响的数学模型，包括成本 每次怀孕和避免母婴传播的干预措施的有效性。该试验将评估一种新颖的干预措施 弥补在提供综合生殖健康和艾滋病毒护理方面的重大差距，并有可能使 对普遍获得计划生育和消除母婴传播的全球目标做出了重大贡献。

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.