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

健康怀孕的同伴群体

基本信息

批准号：
7621153
负责人：
KATHLEEN F NORR
金额：
$ 51.59万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-10 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7621153
关键词：
AIDS prevention Adolescent Adult Advocate African Age Alcohol or Other Drugs use Assertiveness Attitude Behavior Behavioral Child Collaborations Communities Community Health Systems Community Workers Computer Assisted Conceptions Contraceptive methods Control Groups Country Data Data Collection Decision Making Development Diffuse Evaluation Family Planning Fertility Funding Future Gender Issues HIV HIV Infections Habits Health Health behavior Health education Health system Human immunodeficiency virus test Individual Intention Intervention Interview Knowledge Logistics Malawi Measures Mediating Mediation Methods Modeling Outcome Peer Group Planned Pregnancy Population Pregnancy Prevalence Prevention Prevention education Primary Health Care Publishing Randomized Reporting Reproductive Health Research Resources Rural Rural Community Sampling Schools Self Efficacy Services Sex Behavior Sexuality Surveys Symptoms Testing Theoretical model Training Treatment Efficacy UNFPA United Nations Unplanned pregnancy Woman World Health Organization base comparison group condoms cost effectiveness design diet and exercise efficacy testing girls group intervention group support health care model high risk improved innovation peer post intervention prevent programs public health relevance rehearsal role model safer sex sexually active skills unintended pregnancy

项目摘要

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.

描述（由申请人提供）：在高艾滋病毒流行率的情况下，维持最佳的生殖健康对15-20岁的马拉维农村妇女构成了严重的困境，这些妇女对自己的性和生育能力对她们和未来的孩子都有健康影响做出了行为选择。最佳生殖健康需要这些概念概念的行为：更安全的性行为（弃权或使用避孕套），以防止性传播感染，包括HIV感染；性传播疾病的治疗；保持良好的健康习惯，例如饮食，运动和避免使用物质；使用有效的计划生育方法来防止意外怀孕；并定期进行艾滋病毒测试，并在构想打算时与伴侣进行。但是，马拉维的任何计划都没有提供全面的综合方法来促进最佳的生殖健康。另外，我们没有发现整合构思和艾滋病毒/性传播疾病的问题的已发表计划。为了填补这一空白，我们开发了Mzanga干预，这是一个以社区为基础的同伴小组干预，由两名受过当地卫生工作者协助的训练有素的社区年轻妇女领导。 Mzanga干预整合了行为变化模型，包括发展和性别问题在内的上下文剪裁以及谁初级保健原则。我们将使用延迟对照组的纵向，两组比较设计来测试这种干预的功效。十八个地理区域的农村社区将按距主要铺装道路的大小和距离进行分层，然后随机分配给干预措施和延迟的控制条件。损耗后，干预组和对照组中的最终样本将提供足够的能力来检测介质效应。我们假设在基线后9和15个月（干预后6个月和12个月）与对照组相比，干预组将具有更积极的介导和行为结果。介导的结果变量包括知识，态度，感知的规范，自我效能感以及对每个行为结果的意图。行为结果是弃权或持续使用避孕套，除非预期妊娠；在STI症状的健康中心两周内寻求迅速治疗；保持营养饮食，定期运动并避免使用物质；使用有效的计划生育方法，除非预期怀孕，否则请定期进行艾滋病毒测试，并在想法时与伴侣进行伴侣。干预发生在9波跨9波，每个波的4个同伴组。在基线评估之后，干预小组将接受8个会话干预。结果将在基线后9和15个月进行评估。所有评估将使用音频计算机辅助自我访问浏览。延迟对照组将在评估15个月后接受干预。数据将使用Logistic和OLS回归分析。如果这种创新的干预措施有效，这项研究将为促进马拉维及其整个非洲地区的妇女及其婴儿提供最佳的生殖健康，包括艾滋病毒预防，包括艾滋病毒预防。公共卫生相关性：15-20岁的马拉维妇女妇女受到艾滋病毒感染，计划外怀孕以及将艾滋病毒传递给婴儿的高风险，但很少有计划可以帮助她们解决这些问题。拟议的研究将开发和测试同伴LED干预措施，以将预防HIV与妊娠计划相结合。这项研究将为促进马拉维及其整个非洲地区的妇女及其婴儿预防妊娠计划和预防艾滋病毒做出重大贡献。