背景:在撒哈拉以南非洲,少女和年轻妇女(AGYW)占新的艾滋病毒感染和意外怀孕的很大比例,但在获得计划生育和生殖健康(FPRH)信息和服务方面面临许多障碍。通过以人为本的设计开发,MalkiaKlabu(“女王俱乐部”)计划旨在促进在私营药店获得艾滋病毒自我检测(HIVST)和FPRH信息和产品。我们试图了解坦桑尼亚为期4个月的试点项目实施的障碍和促进者。
方法:从2019年11月至2020年3月,在MalkiaKlabu计划的整群随机试验中,对参与者进行了40次半结构化访谈,其中包括11名AGYW,26与毒品店主,和三个在医疗机构的顾问,AGYW被转诊。采访是录音的,转录,编码,并进行分析以确定关键主题。实施研究综合框架(CFIR)用于评估多层次计划实施的障碍和促进者。CFIR考虑外部设置(例如,文化和系统条件),实施干预的内部设置(例如,激励机制,关系,和可用资源),涉及的个人,与利益相关者需求相关的创新,和实施过程。
结果:MalkiaKlabu计划重塑并指导了药品店主作为信息和资源提供者而不是FPRH看门人的角色。关键的实施促进者包括该计划对AGYW中各种需求和准备阶段的适应性,利用AGYW社交网络推动会员资格的能力,响应AGYW对隐私的需求,以及对毒品店主的收入和社区地位的积极贡献。HIVST等组件对AGYW和店主来说都是高度可接受的,在商店中引入忠诚度计划和HIVST套件为提供FPRH产品和信息打开了大门,视频等程序工具进一步促进了这一点,产品展示,和符号卡。尽管一些店主坚持认为某些避孕方法不适合AGYW,大多数人似乎将产品作为计划的一部分提供。
结论:MalkiaKlabu干预的成功部分是由于它能够解决AGYW和药品店主的关键动机,例如维护隐私和增加AGYW对FPRH产品的访问,以及增加商店的业务。更好地了解这些实施障碍和促进者可以为计划的未来适应和扩大提供信息。
背景:clinicaltrials.gov#NCT04045912。
撒哈拉以南非洲的少女和年轻妇女(AGYW)获得计划生育和生殖健康产品和信息的机会有限,尽管她们怀孕和感染艾滋病毒的风险更大。MalkiaKlabu干预是与AGYW和私人药店的店主一起设计的,目的是通过包括免费产品在内的忠诚度计划来促进对产品和信息的访问。购买奖品,教育视频,以及通过符号请求产品的非语言系统。对AGYW的合格采访,药店的工作人员,和卫生系统顾问建议,该计划有助于为AGYW提供更大的隐私和信心,同时为药店带来新的业务。这些发现可以帮助研究小组绘制扩大干预措施的途径。
BACKGROUND: Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu (\"Queen Club\") program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania.
METHODS: Forty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process.
RESULTS: The Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program\'s adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW\'s need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program.
CONCLUSIONS: The Malkia Klabu intervention\'s success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program\'s future adaptation and scale-up.
BACKGROUND: clinicaltrials.gov #NCT04045912.
Adolescent girls and young women (AGYW) in sub-Saharan Africa have limited access to family planning and reproductive health products and information even though they are at greater risk of pregnancy and HIV infection. The Malkia Klabu intervention was designed with AGYW and shopkeepers from private drug shops to facilitate access to products and information through a loyalty program that included free products, prizes for purchases, educational videos, and a non-verbal system of requesting products through symbols. Qualitive interviews with AGYW, drug shop staff, and health system counselors suggested that the program helped provide greater privacy and confidence to AGYW while bringing new business to drug shops. These findings can help as the study team charts a pathway for scaling up the intervention.