AmbassADDOrs for Health: Supporting young women's health through girl-friendly drug vendors

摘要 撒哈拉以南非洲的少女和年轻妇女(15-24岁)面临艾滋病毒的双重威胁 感染和意外怀孕，严重损害了她们的长期福祉。然而，尽管 迫切需要向AGYW提供性健康和生殖健康(SRH)服务，卫生系统经常生病 有能力克服AGYW在卫生保健服务方面面临的众多障碍。这项研究的目标是 为了评估坦桑尼亚的Malkia KLabu(女王俱乐部)，一个忠诚度计划干预创建了AGYW- 友好的药店，在那里AGYW可以获得艾滋病毒预防服务和避孕。其动机是 这种做法是越来越多的人认识到，药店分布广泛，数量远远超过 卫生设施，可以促进有益的健康行为，弥合卫生服务方面的差距，并减轻健康 劳动力短缺。此外，虽然艾滋病毒检测是艾滋病毒预防和护理的门户，但自我检测 尽管整个地区的政府都在采用，但AGYW并没有广泛采用口服液。 基于一项初步研究的有希望的数据，我们假设，创造一个友好的环境 通过马尔基亚克拉布干预，将吸引AGYW并促进对包括艾滋病毒在内的SRH服务的接受 自检(HIVST)试剂盒和避孕措施，从而增加AGYW中意识到其 艾滋病毒状况，并有能力避免意外怀孕。我们设计了一种创新的、混合的方法 评估马尔基亚克拉布干预措施的研究，该干预措施是为AGYW设计的，由AGYW设计，以创建AGYW友好型 药店在提供HIVST的同时还提供避孕和护理联系。具体地说，我们为期5年的研究 包括在40个卫生设施集水区进行整群随机试验(C-RCT)，以评估干预措施的 AGYW在人口一级对艾滋病毒诊断和产前护理登记的成效(目标1)。 然后，我们会将这些结果与个人层面的行为联系起来(例如，最近的艾滋病毒检测，未满足 避孕、与护理的联系)和其他需求侧途径导致对RDS调查的影响和 与AGYW的焦点小组(目标2)。最后，一项混合方法、实施科学研究将确定供应- 影响有效性的副作用因素(例如，实施模式、干预保真度、商店特征； 目标3)。在研究结束时，我们将严格评估马尔基亚克拉布，发现 提高计划成功率，并描述与实施保持一致的潜在影响途径 以科学的方法弥合证据和实践之间的差距。这个研究团队是一个协作组 在加州大学(旧金山和伯克利)、健康促进繁荣国家、 坦桑尼亚卫生、社区发展、性别、老年人和儿童部以及坦桑尼亚 药房委员会。 这项拟议的研究将首次严格探索是否可以使用对AGYW友好的药店 向AGYW分发艾滋病毒预防和SRH服务，以及这个基于社区的平台是否 分发值得推广，以惠及坦桑尼亚和该地区脆弱的AGYW。

SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face the dual threats of HIV infection and unintended pregnancy that severely undermine their long-term wellbeing. However, despite the urgent need to reach AGYW with sexual and reproductive health (SRH) services, health systems are often ill equipped to overcome the numerous barriers to health care services faced by AGYW. The goal of the study is to evaluate Malkia Klabu (“Queen Club”) in Tanzania, a loyalty program intervention that creates AGYW- friendly drug shops where AGYW can access HIV prevention services and contraception. The motivation for this approach is the growing recognition that drug shops, which are widely distributed and vastly outnumber health facilities, can promote beneficial health behaviors, bridge gaps in health services, and mitigate health workforce shortages. Furthermore, although HIV testing is the gateway to HIV prevention and care, self-testing with oral fluid has not been widely adopted by AGYW, despite government adoptions across the Region. Based on promising data from a pilot study, we hypothesize that the creation of a welcoming environment through the Malkia Klabu intervention will attract AGYW and bolster uptake of SRH services, including HIV self-test (HIVST) kits and contraception, thereby increasing the proportion of AGYW who are aware of their HIV status and empowered to avoid unintended pregnancy. We have designed an innovative, mixed-methods study to evaluate the Malkia Klabu intervention, which was designed for and by AGYW to create AGYW-friendly drug shops where HIVST is available alongside contraception and linkages to care. Specifically, our 5-year study includes a cluster-randomized trial (C-RCT) in 40 health facility catchment areas to evaluate the intervention’s effectiveness on HIV diagnoses and antenatal care registrations among AGYW at the population level (Aim 1). We will then link these outcomes to individual-level behaviors (e.g., recent HIV testing, unmet for contraception, linkage to care) and other demand-side pathways leading to impact with a RDS survey and focus groups with AGYW (Aim 2). Finally, a mixed-methods, implementation science study will pinpoint supply- side factors influencing effectiveness (e.g., implementation models, intervention fidelity, shop characteristics; Aim 3). At the study’s conclusion, we will have rigorously evaluated Malkia Klabu, uncovered factors that enhance program success, and described potential pathways of impact, consistent with an implementation science approach to close the gap between evidence and practice. The research team is a collaboration between the University of California (San Francisco and Berkeley), Health for a Prosperous Nation, the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children, and the Tanzania Pharmacy Council. The proposed study will rigorously explore, for the first time, whether AGYW-friendly drug shops can be used to distribute HIV prevention and SRH services to AGYW and whether this community-based platform of distribution is worthy of scaling to reach vulnerable AGYW across Tanzania and the Region.