Peer Groups for Healthy Pregnancy & HIV Prevention for Young Malawian Women
Condition: HIV; Pregnancy; Sexually Transmitted Infections
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to test the efficacy of an innovative, culturally relevant,
      community-based peer group intervention to increase young rural Malawian women's
      preconception behaviors to optimize their reproductive health. The study uses a longitudinal,
      two group (two-arm) design with a delayed control group.
    

Detailed description: 
      Maintaining optimal reproductive health in the context of high HIV prevalence is a serious
      dilemma facing young women in Malawi and other high HIV prevalence countries. Optimal
      reproductive health requires practicing preconception behaviors to promote overall health
      including avoiding HIV infection. These healthy preconception behaviors include: practicing
      safer sex (abstaining or using condoms) to prevent sexually transmitted infections (STIs),
      including HIV infection; obtaining treatment for STIs; maintaining good health habits such as
      diet, exercise and avoiding substance use; using an effective family planning method to
      prevent unintended pregnancy; and having an HIV test periodically and with the partner when
      conception is intended. However the Malawi Demographic and Health Survey provides evidence
      that few women ages 15-20 in Malawi currently practice these healthy preconception behaviors.
      Currently, no programs in Malawi offer an integrated approach to optimal reproductive health.

      To fill this gap, this study developed an innovative, culturally relevant, community-based
      peer group intervention to increase young rural Malawian women's preconception behaviors to
      optimize their reproductive health. The intervention is called Mzanga Samala Moyo Wako
      ([Mzanga] Sharing Responsibility for Pregnancy Planning and HIV Prevention). Mzanga builds on
      the investigators' previous research in Malawi, which tested a culturally relevant HIV
      prevention peer group intervention that changed HIV prevention-related knowledge, attitudes,
      and safer sex behaviors for rural adults and adolescents. This study integrated that prior
      HIV prevention content with new content on maintaining health, family planning, and
      preconception HIV testing.

      The purpose of this study is to test Mzanga's efficacy using a longitudinal, two group (two
      arm) design: intervention group and delayed control group. Because Mzanga is expected to
      diffuse widely, we randomize at the community rather than the individual level. Eighteen
      geographically separate rural communities stratified by size and distance from the main paved
      road and then randomly assigned to Mzanga or the delayed control condition. We implement
      Mzanga in 9 waves. A final sample of 345 per group after attrition provides adequate power
      (80%) to detect small-to-medium effects. After baseline data collection, the Mzanga group
      receives the eight-session intervention. Outcomes are measured at 9 months post-baseline (6
      months post-intervention), followed by a booster session for the Mzanga group, and final
      evaluation at 15 months post-baseline. After the 15-month data collection, Mzanga is offered
      to the delayed control group.

      The study aims and hypotheses are:

      Aim 1. To test the efficacy of the Mzanga intervention for improving reproductive health
      outcome mediating and behavioral variables for Malawian rural young women at 9 and 15 months
      post-baseline.

      H1.Controlling for baseline differences and group effects, compared to the delayed control
      group, the intervention group will show more positive mediating and behavioral outcomes:

        1. Practice safer sex,

        2. Obtain prompt treatment for STI symptoms;

        3. Maintain good health habits (diet, exercise, substance use);

        4. Use an effective family planning method except when pregnancy is intended;

        5. Have an HIV test periodically, with partner when conception is intended; and

        6. More positive scores for the mediating variables of knowledge, attitudes, perceived
           norms, self-efficacy, and intentions for each of these behaviors.

      Aim 2. To test a theoretical model of the mechanisms through which the Mzanga intervention
      changes preconception health behaviors of young women in rural Malawi.

      H2. Mzanga's effects on healthy preconception behaviors (a-e above) will be mediated by
      knowledge, attitudes, perceived norms, self-efficacy, and intention scores.
    

Intervention name(s): Mzanga Samala Moyo Wako ([Mzanga] Peer Groups
Intervention type(s): Behavioral
Intervention description(s): 8 small group sessions led by community young women, focused on reproductive health, including HIV, STI and unintended pregnancy prevention; includes skill-building for self-efficacy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: HIV; Prevention; unintended pregnancy; Malawi; adolescent women; community; rural