Peer groups for healthy pregnancy & HIV prevention for young Malawian women

描述（由申请人提供）：在艾滋病毒高流行的背景下，保持最佳生殖健康使15-20岁的年轻马拉维农村妇女面临严重困境，她们在性行为和生育方面做出的行为选择对她们及其未来子女的健康有影响。最佳的生殖健康需要以下受孕前行为：安全性行为（禁欲或使用避孕套）以预防性传播感染，包括艾滋病毒感染；性传播感染治疗；保持良好的健康习惯，如饮食、运动和避免使用药物；采用有效的计划生育方法，防止意外怀孕；定期进行艾滋病毒检测，并在怀孕时与伴侣一起进行检测。然而，马拉维没有任何方案提供全面、综合的方法来促进最佳生殖健康。此外，我们也没有发现将怀孕和预防艾滋病毒/性传播感染问题结合起来的公开项目。为了填补这一空白，我们制定了Mzanga干预措施，这是一项以社区为基础、以文化为基础的同伴团体干预措施，由两名受过培训的社区年轻妇女领导，并得到一名当地卫生工作者的协助。Mzanga干预措施整合了行为改变模型、量身定制（包括发展和性别问题）以及世卫组织初级卫生保健原则。我们将采用纵向、两组比较设计和延迟对照组来测试该干预措施的有效性。18个地理上分开的农村社区将根据大小和距离主干道的距离进行分层，然后随机分配到干预和延迟控制条件。经过磨耗后，干预组和对照组的345名最终样本将提供足够的力量来检测中等效应。我们假设在基线后9和15个月（干预后6和12个月），与对照组相比，干预组将有更多积极的中介和行为结果。中介结果变量包括知识、态度、知觉规范、自我效能感和每个行为结果的意图。行为上的结果是，除非有意怀孕，否则不使用或坚持使用避孕套；在出现性传播感染症状的两周内到保健中心寻求及时治疗；保持营养饮食，定期锻炼，避免使用药物；除有意怀孕外，使用有效的计划生育方法，并在有意怀孕时与伴侣定期进行艾滋病毒检测。干预分9波进行，每波有4个同伴组。基线评估后，干预组将接受8次干预。结果将在基线后9个月和15个月进行评估。所有评估都将使用计算机辅助的音频自我访谈进行。延迟对照组在15个月评估后接受干预。数据将使用逻辑和OLS回归进行分析。如果这一创新干预措施有效，这项研究将为促进马拉维和整个非洲地区妇女及其婴儿的最佳生殖健康，包括预防艾滋病毒作出重大贡献。

DESCRIPTION (provided by applicant): Maintaining optimal reproductive health in the context of high HIV prevalence poses a serious dilemma for young rural Malawian women ages 15-20 who make behavioral choices regarding their sexuality and fertility that have health implications for them and their future children. Optimal reproductive health requires these preconceptual behaviors: safer sex (abstaining or using condoms) to prevent STIs, including HIV infection; treatment for STIs; maintaining good health habits such as diet, exercise and avoiding substance use; using an effective family planning method to prevent unintended pregnancy; and having an HIV test periodically and with the partner when conception is intended. However, no programs in Malawi offer a comprehensive, integrated approach to promoting optimal reproductive health. Also, we found no published programs that integrate issues of conceiving and HIV/STIs prevention. To fill this gap, we developed the Mzanga intervention, a community-based culturally grounded peer group intervention led by two trained community young women assisted by a local health worker. The Mzanga intervention integrates behavioral change models, contextual tailoring including developmental and gender issues, and WHO primary health care principles. We will test the efficacy of this intervention using a longitudinal, two-group comparison design with a delayed control group. Eighteen geographically separate rural communities will be stratified by size and distance from the main paved road and then randomly assigned to the intervention and delayed control conditions. After attrition, a final sample of 345 in the intervention and in the control groups will provide adequate power to detect medium effects. We hypothesize that at 9 and 15 months post-baseline (6 and 12 months post-intervention), compared to the control group, the intervention group will have more positive mediating and behavioral outcomes. Mediating outcome variables include knowledge, attitudes, perceived norms, self-efficacy, and intention for each of the behavioral outcomes. Behavioral outcomes are abstaining or consistently using condoms except when pregnancy is intended; seeking prompt treatment within two weeks at the health center for STI symptoms; maintaining a nutritious diet, exercising regularly, and avoiding substance use; using an effective family planning method except when pregnancy is intended, and having an HIV test periodically and with the partner when conception is intended. The intervention occurs across 9 waves, with 4 peer groups per wave. Following baseline assessment, the intervention group will receive the 8 session intervention. Outcomes will be evaluated at 9 and 15 months post-baseline. All evaluation will be conducted using an audio computer-assisted self-interview. The delayed control group will receive the intervention after the 15 month evaluation. Data will be analyzed using logistic and OLS regression. If this innovative intervention is effective, this research will make a major contribution toward promoting optimal reproductive health, including HIV prevention, for women and their babies in Malawi and throughout the African region. PUBLIC HEALTH RELEVANCE: Young rural Malawian women ages 15-20 are at high risk of HIV infection, unplanned pregnancy, and passing HIV to their babies, yet few programs exist that help them deal with these issues. The proposed research will develop and test a peer led intervention to integrate HIV prevention with pregnancy planning. This research will make a major contribution toward promoting pregnancy planning and HIV prevention for women and their babies in Malawi and throughout the African region.