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

Mobile WACh Empower：为感染艾滋病毒的女性提供生殖生活规划的移动解决方案

基本信息

批准号：
10410570
负责人：
Alison L Drake
金额：
$ 68.17万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10410570
关键词：
Address Africa South of the Sahara Behavior Behavioral Caring Climate Clinic Communication Complex Conceptions Consolidated Framework for Implementation Research Contraceptive Agents Contraceptive Usage Contraceptive methods Counseling Custom Data Decision Making Drug Interactions Effectiveness of Interventions Enrollment Ensure Environment Evaluation Face Family Planning Fertility Focus Groups Goals HIV Health Health Personnel Health Technology Health system Healthcare Systems Intervention Justice Kenya Lead Life Maternal and Child Health Maternal-Child Health Services Measures Methods Modeling Mother-to-child HIV transmission Motion Motivation Outcome Patients Pharmaceutical Preparations Planned Pregnancy Population Pregnancy Prevention Provider Randomized Controlled Trials Readiness Reproductive Health Reproductive Health Services Resource-limited setting Resources Rights Risk STI prevention Selection for Treatments Self Efficacy Services Site Surveys Testing Time Training Treatment Protocols Viral Woman acceptability and feasibility antiretroviral therapy arm base care providers cost cost effective cost effectiveness cost estimate design economic evaluation economic impact experience future implementation health care service health economics health goals healthy pregnancy implementation barriers implementation science improved internalized stigma intervention cost mHealth mathematical model meeting abstracts meetings microcosting novel postpartum contraception pregnancy prevention prevent programs reproductive secondary outcome service delivery side effect skills standard of care texting support theories tool treatment arm two way texting unintended pregnancy

项目摘要

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.

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)。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撒哈拉以南非洲地区的许多计划都纳入了怀孕和不良孕产妇和儿童健康结果。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。艾滋病毒护理服务不断提到实施挑战。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我们致力于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我们将采用独特的双向短信平台（Mobile WACh）来预防母婴传播。为新人群、新人群自动发送短信并与医疗保健提供者对话 Mobile WACh 平台将根据环境和新成果进行定制。为 WLWH 提供持续的生殖生活规划咨询我们将测试联合干预措施。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 的效果在目标 1 中，我们将确定移动 WACh 的影响。在目标 2 中，对 FP 终止、双重方法使用和未满足的 FP 需求进行干预。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目标 3 中，我们将从 WLWH 和提供商的角度构建世界环境。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。