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

• 批准号: 10254868
• 负责人: Alison L Drake
• 金额: $ 75.86万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 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/10254868
• 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; Future; 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; 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; health care service; health economics; health goals; healthy pregnancy; implementation barriers; implementation science; improved; intervention cost; mHealth; mathematical model; meeting abstracts; meetings; microcosting; novel; postpartum contraception; pregnancy prevention; prevent; programs; reproductive; secondary outcome; service delivery; side effect; skills; social stigma; standard of care; theories; tool; treatment arm; unintended pregnancy

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.

项目摘要/摘要 满足艾滋病毒妇女（WLWH）妇女的生殖健康需求对于帮助妇女防止妇女至关重要 意外怀孕，安全地怀孕并消除了母亲艾滋病毒的传播（MTCT）。生殖 对于WLWH而言，生活计划很复杂，他们面临有关抗逆转录病毒治疗选择的决定 以及药物相互作用与避孕方法，安全构想和STI预防的潜力。 虽然计划生育（FP）在WLWH中使用量很高，但FP中停用的女性很常见 欲望预防怀孕，是对FP的不满意的重要驱动力，随后发生意外的风险 怀孕和不良儿童健康结果。撒哈拉以南非洲的许多计划融合 FP服务提供给常规的艾滋病毒护理，但艾滋病毒护理提供者在实施这些模型方面面临挑战 照顾。 HIV护理提供者可能不等同，以确保WLWH获得高质量的基于权利的生殖 由于缺乏时间，培训，资源和技能而导致的健康咨询和服务。关于整合FP的先前研究 艾滋病毒护理的服务始终引用实施挑战。移动卫生技术可能会提供低 增加咨询服务，更强大的医疗保健系统的成本解决方案，并减轻对艾滋病毒的需求 提供者。我们假设提供全面的咨询和双向短信通信， 1）改善综合艾滋病毒和生殖保健服务的交付，2）减少避孕药 中断率，3）可以接受和可行，4）具有成本效益并贡献 预防MTCT努力。我们将调整一个唯一组合的双向SMS平台（移动WACH） 自动散装SMS消息传递和与医疗保健提供者的对话，以提供新的人群 环境和长期影响的新结果。移动WACH平台将被定制为 为WLWH提供连续的生殖生活计划咨询。我们将测试一个合并干预措施 在肯尼亚10个设施接受HIV护理的妇女中，群集随机对照试验（每个设施330个）。 我们建议评估咨询和短信交流干预的影响，移动WACH 授权，关于生殖健康结果。在AIM 1中，我们将确定移动WACH的效果 授权干预FP停用，双重方法的使用以及2年内FP的未满足需求。在AIM 2中， 我们将评估实施移动WACH授权的可接受性，可行性和可伸缩性 从WLWH和提供者的角度来看，世界设置在焦点小组讨论中。在AIM 3中，我们将构建 一种数学模型，用于衡量移动WACH授权的健康和经济影响，包括成本 - 每次怀孕和MTCT避免干预的有效性。该试验将评估新颖的干预措施 解决有关提供综合生殖健康和艾滋病毒护理的关键差距，并有可能使 对全球访问FP和消除MTCT的全球目标的重要贡献。