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: 10805668
• 负责人: Jenny Xin Liu
• 金额: $ 8.79万
• 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/10805668
• 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; Equity; Face; Failure; Female Adolescents; Focus Groups; Fostering; Friends; 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; Vendor; Visit; Women' s Health; Youth; antenatal care; barrier to care; base; behavior change; care seeking; design; effectiveness evaluation; empowerment; 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 撒哈拉以南非洲地区的少女和年轻女性（AGYW；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健康。 迫切需要向 AGYW 提供性健康和生殖健康 (SRH) 服务，但卫生系统经常出现问题 该研究的目标是克服 AGYW 面临的医疗保健服务的众多障碍。 评估坦桑尼亚的 Malkia Klabu（“女王俱乐部”），这是一项忠诚度计划干预措施，创建了 AGYW- AGYW 可以在友好的药店获得艾滋病毒预防服务和避孕服务。 这种方法是人们越来越认识到药店分布广泛且数量远远超过 卫生设施，可以促进有益的健康行为，缩小卫生服务差距，并减轻健康 此外，尽管艾滋病毒检测是艾滋病毒预防和护理的门户，但自我检测仍然存在。 尽管整个地区政府都采用了口腔液治疗，但 AGYW 尚未广泛采用。 根据一项试点研究的有希望的数据，我们发现创造一个受欢迎的环境 通过 Malkia Klabu 干预措施将吸引 AGYW 并促进对 SRH 服务（包括艾滋病毒）的采用 自检 (HIVST) 套件和避孕措施，从而提高了解自己情况的 AGYW 比例 我们设计了一种创新的混合方法，以了解艾滋病毒状况并有权避免意外怀孕。 研究评估 Malkia Klabu 干预措施，该干预措施是为 AGYW 设计并由 AGYW 设计，旨在创建 AGYW 友好型 药店提供 HIVST 以及避孕和护理服务，具体来说，是我们为期 5 年的研究。 包括在 40 个医疗机构服务区域进行整群随机试验 (C-RCT)，以评估干预措施的效果 人口层面 AGYW 艾滋病毒诊断和产前保健登记的有效性（目标 1）。 然后，我们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、未满足的 避孕、与护理的联系）和其他需求方途径，从而影响 RDS 调查和 最后，一项混合方法、实施科学研究将确定供应- 影响有效性的侧面因素（例如实施模式、干预保真度、商店特征； 目标 3) 在研究结束时，我们将对 Malkia Klabu 进行严格评估，发现影响因素 提高计划成功率，并描述与实施相一致的潜在影响途径 缩小证据与实践之间差距的科学方法是一个合作研究团队。 加利福尼亚大学（旧金山和伯克利）之间的健康繁荣国家组织 坦桑尼亚卫生部、社区发展、性别、老年人和儿童以及坦桑尼亚 药学委员会。 拟议的研究将首次严格探索 AGYW 友好型药店是否可以使用 向 AGYW 分发艾滋病毒预防和性健康与生殖健康服务，以及这个基于社区的平台是否 值得扩大分发范围，以覆盖坦桑尼亚和该地区脆弱的 AGYW。