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

AmbassADDOrs for Health：通过对女孩友好的毒贩支持年轻女性的健康

• 批准号: 10402324
• 负责人: Jenny Xin Liu
• 金额: $ 102.22万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-06 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402324
• 关键词: AIDS prevention; Accreditation; Adopted; Adoption; Adult; Africa; Africa South of the Sahara; Age; Area; Awareness; Behavior; Birth; Businesses; California; Caring; Catchment Area; Characteristics; Child; Client; Clinic; Cluster randomized trial; Collaborations; Communities; Community Developments; Community-Based Distributions; Contraceptive Agents; Contraceptive methods; Counseling; Data; Diagnostic Reagent Kits; Effectiveness; Effectiveness of Interventions; Elderly; Environment; Face; Failure; Female Adolescents; Focus Groups; Fostering; Gender; Goals; Government; HIV; HIV Infections; HIV diagnosis; HIV-infected adolescents; Health; Health Personnel; Health Services; Health behavior; Health care facility; Health system; Heterogeneity; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Link; Liquid substance; Long-Term Effects; Methods; Modeling; Motivation; Oral; Outcome; Pathway interactions; Perception; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Pilot Projects; Population; Pregnancy; Pregnancy Tests; Prevention; Private Sector; Privatization; Program Effectiveness; Provider; Randomized; Records; Reporting; Reproductive Health; Reproductive Health Services; Research; Respondent; Risk; Role; Sales; Sampling; San Francisco; Services; Sexual Health; Side; Signal Transduction; South Africa; Surveys; Tanzania; Time; Universities; Ursidae Family; Vendor; Visit; Women' s Health; Youth; antenatal care; barrier to care; base; behavior change; care seeking; design; effectiveness evaluation; empowered; enhancing factor; girls; health care service; human centered design; implementation fidelity; implementation science; implementation strategy; improved; innovation; intervention program; prevention service; primary outcome; programs; recruit; secondary outcome; self testing; social stigma; standard of care; success; unintended pregnancy; uptake; vulnerable adolescent; young woman

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.

概括 撒哈拉以南非洲的青春期女孩和年轻妇女（AGYW； 15-24岁）面临艾滋病毒的双重威胁 感染和意外怀孕严重破坏了他们的长期健康。但是，要求 迫切需要通过性和生殖健康（SRH）服务达到AGYW，卫生系统常常病态 能够克服AGYW面临的众多卫生保健服务障碍。研究的目的是 评估坦桑尼亚的Malkia Klabu（“皇后俱乐部”），这是一种忠诚计划干预措施，创造了Agyw- AGYW可以在这里获得艾滋病毒预防服务和避孕的友好药店。动机 这种方法是人们越来越认识到，分布广泛且人数远远超过的药店 卫生设施可以促进有益的健康行为，卫生服务中的桥梁差距并减轻健康 劳动力短缺。此外，尽管艾滋病毒测试是预防艾滋病毒和护理的门户，但自我测试 AGYW尚未广泛采用口服流体，该地区的政府收养目的地。 基于一项试点研究的承诺数据，我们假设创造了热情的环境 通过Malkia Klabu干预将吸引AGYW并支持SRH服务的吸收，包括艾滋病毒 自我测试（HIVST）套件和避孕套件，从而增加了意识到自己的AGYW的比例 艾滋病毒状况并有权避免意外怀孕。我们设计了一种创新的混合方法 评估Malkia Klabu干预的研究，该干预是为AGYW设计的，以创建AGYW友好型 HIVST的药店与避孕和关联一起提供。具体而言，我们的5年研究 包括40个医疗机构集水区的集群随机试验（C-RCT），以评估干预措施 对人群级别的AGYW，对HIV诊断和产前护理注册的有效性（AIM 1）。 然后，我们将将这些结果与个人级别的行为联系起来（例如，最近的艾滋病毒测试，未得到满足 避孕，与护理的联系）以及其他需求方途径，导致RDS调查和 具有AGYW的焦点小组（AIM 2）。最后，实施科学研究的混合方法将确定供应 - 副因素会影响有效性（例如，实施模型，干预保真度，商店特征； 目标3）。在研究的结论中，我们将严格评估Malkia Klabu，发现了这些因素 增强计划的成功，并描述了潜在的影响途径，与实施一致 缩小证据与实践之间差距的科学方法。研究团队是一项合作 在加利福尼亚大学（旧金山和伯克利分校）之间，一个繁荣国家的健康 坦桑尼亚卫生，社​​区发展，性别，老年人和儿童以及坦桑尼亚 药房委员会。 拟议的研究将首次严格探索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 分布值得扩展到整个坦桑尼亚和该地区的脆弱AGYW。