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Sponsor: Liverpool School of Tropical Medicine
Conditions: Unmet Need for Contraception, Uptake of HIV Prevention, Healthy Participants
Interventions: MASCOT
Countries: Zimbabwe
Young people of ages 15-24 years, particularly those in Sub-Saharan Africa, do not optimally take up HIV services (HIV testing, HIV prevention and HIV treatment) and contraception. The number of new HIV infections in this group is disturbingly high and they suffer a lot of illness and death related to HIV. Research has found that four out of five sexually active adolescents in Africa are not using contraception. This means that millions of young people are exposed to unintended pregnancy and the associated negative effects such as unsafe abortions, school drop-out and reduced opportunities for both mother and baby. World Health Organisation have issued new guidelines for a new strategy, self-care, where an individual takes care of their own health and manages their illness with or without the support of a health worker. Self-care has potential to increase the number of young people who use HIV and contraception services. There is not enough information on how self-care can be done in a way that supports people to use services and maintain this use over time. Self-care can be made easier by mobile phone-based digital systems called mHealth, which may work by supporting access of services, for example where products are ordered online, or creating enabling conditions for self-care, for example through facilitating correct information-giving. With various options for HIV prevention and contraception available, young people may need support/guidance choosing options that suit them. Health workers in overburdened health systems may be too overwhelmed to clearly present all options to guide informed decisions. Decision aids (tools that support patients/users to make informed choices that suit their values and preferences) can enhance self-care by enabling informed decisions. Decision aids for HIV prevention and contraception need to be developed for use in self-care settings. Combining decision aids with mHealth tools can enhance self-care. This study will be co-developed with students enrolled in colleges/universities in Zimbabwe to develop a self-care strategy that includes mHealth together with decision aids and enables students to optimally use HIV and contraception services. The study is divided into five stages, and builds on another study where a self-care strategy supported by an mHealth tool (without decision aids) was developed. In the first stage of the current study, preferences for decision aids and attributes to include in the mHealth tool will be obtained using qualitative research and a scoping literature review. In the second stage, findings from the first stage will be used to develop blueprints for two decision aids: one for contraception and the other for HIV prevention. In the third stage, the decision aids will be integrated with the existing mHealth tool through a crowdsourcing activity including students, and experts in health and mHealth. In the fourth stage the self-care strategy supported by mHealth and decision aids will be tested in a pilot at 2 colleges/universities. Finally, the fifth stage be a randomised control trial, across college/universities in Zimbabwe, to see whether the self-care strategy supported by mHealth and decision aids will be effective to promote self-care, and therefore, results in an increase in the uptake of HIV and contraception services. This study will also be applied to make recommendations on how the strategy can be provided outside of college/university contexts.
Sex: ALL
Age: 16 Years to 60 Years
Healthy volunteers: Yes
Study type: INTERVENTIONAL
Work package 1: Formative research 1. Focus Group Discussions * Aged 16 years old or over; * Currently enrolled at a college/university where the research is being done; * Willing and able to provide written informed consent. Exclusion Criteria: \- None stated 2. Key informant interviews * Staff from MoHCC responsible for implementing or supervising implementation of HIV or sexual and reproductive health services, or for policy planning on the same topics, * Staff from Ministry of Higher and Tertiary Education responsible for student health, staff from Ministry of Health implementing partners working on HIV and sexual and reproductive health services in Zimbabwe, * Willing and able to provide written informed consent. Exclusion Criteria: \- None stated Work package 3: Adaptation of the parent mHealth tool 1\. Hackathon 1a. Students Inclusion criteria: * Enrolled in the specific institutions; in these disciplines: public health, information technology and computer science; and * Willing to take part in the hackathon Exclusion criteria: None stated 1b. Multi-disciplinary experts Inclusion criteria: * Representatives in any of the following disciplines, Digital health experts, MoHCC, HIV and SRH services, other key stakeholders; and * Willing to take part in the hackathon. Exclusion criteria: None stated 2\. Alpha testing 2a. Students Inclusion criteria: • Recruited from the same colleges/universities that participated in formative research • Willing and able to provide written informed consent. Exclusion criteria: None stated 2b. Health workers Inclusion criteria: * Staff from MoHCC responsible for implementing or supervising the implementation of HIV and sexual and reproductive health services, * Willing and able to provide written informed consent. Exclusion criteria: None stated 3\. Beta testing 3a. Students Inclusion criteria: * Students who have used the mHealth tool and decision aids * Willing and able to provide written informed consent. Exclusion Criteria: \- None stated 4\. Pilot of mHealth supported self-care in two colleges/universities 4a. Institutions Inclusion criteria: * Less than 3500 students * Comparable male and female ratio * Participated in formative research Exclusion criteria: Institutions that participated in the formative research 4b. Peer distributors Inclusion criteria: * Aged \>18 years; * Currently enrolled at the participating colleges/universities * Willing to be a peer distributor, * Willing to conduct study activities according to the protocol. Exclusion criteria: \- Students who were away from college for industrial attachment during intervention implementation 4c. Pilot survey Inclusion criteria: * Students enrolled at the colleges/universities for at least 6 months. * Willing to provide written informed consent for the survey. Exclusion criteria: \- Students who were away from college for industrial attachment during intervention implementation 4d. In-depth interviews with students Inclusion criteria: * Students enrolled at the colleges/universities for at least 6 months. * Willing to provide written informed consent for the in-depth interviews Exclusion criteria: None defined 4e. In depth interviews with Peer Distributors Inclusion Criteria: * Student peer distributor at a tertiary education institution where the research is being done; and * Willing and able to provide written consent for the interview. Exclusion criteria: None defined 4f. FGDs with students Inclusion criteria: * Enrolled at the colleges/universities for at least 6 months. * Willing to provide informed consent for the FGD. Exclusion criteria: None defined 4g. In depth interviews with health workers * Health worker at participating college/university supporting the MASCOT intervention. * Willing and able to provide written informed consent. Exclusion criteria: None defined 5\. Cluster Randomised trial 5a. Institutions Inclusion criteria: * Located in 10 provinces: Harare, Mashonaland Central, West and East, Masvingo, Manicaland, Midlands Bulawayo and Matabeleland North and South * Maximum enrolment of 3500 students Exclusion criteria: None defined 5b. Surveys, in-depth interviews with students, peer distributors and health workers and FDGs with students will be the same as for work package 4 above. 5c. Costing interviews with distributors Inclusion criteria: * Student peer distributor at a tertiary education institution where the research is being done; and * Willing and able to provide written consent for the costing interview. Exclusion criteria: None defined 5d. Costing - Valuing distributor time Inclusion criteria: * Student peer distributor at a tertiary institution where the research is being done. * Willing and able to provide written consent Exclusion criteria: None defined
- Harare, Zimbabwe