Center for Innovative Public Health Research, San Clemente, CA, USA.
Internet Solutions for Kids Uganda, Mbarara, Uganda.
AIDS Behav. 2020 Aug;24(8):2355-2368. doi: 10.1007/s10461-020-02795-4.
In Uganda, HIV prevention programming for older adolescents is noticeably lacking, even though HIV incidence rates increase dramatically from adolescence into young adulthood. Here we describe the development of In This toGether (ITG), the first-of-its-kind, comprehensive text messaging-based HIV prevention program for both sexually active and abstinent 18- to 22-year-old Ugandans. Five iterative development activities are described: (1) conducting focus groups (FGs) to better understand the sexual decision-making of older adolescents across Uganda and to gain 'voice' of older adolescents; (2) the drafting of intervention content based on FG data; (3) testing of the drafted content with two Content Advisory Teams (CATs) that reviewed and provided feedback on the messages; (4) alpha-testing the program among the research team; and (5) beta-testing the intervention and protocol with people in the target population. Participants were recruitment nationally via Facebook and Instagram, and enrolled over the telephone by research staff. Results suggest that men were easier to reach and engage across all intervention development steps. As such, specific efforts to enroll women were made to ensure that feedback from both sexes was taken into account. FG participants said they were interested in learning more about sexual positions, how to prepare for sex, the consequences of unprotected sex, benefits of protected sex, masturbation, and how to be a good sexual partner. In both the FGs (n = 202) and CATs (n = 143) however, some noted that masturbation, oral sex, and anal sex were particularly sensitive topics. These messages were rewritten to address the cultural sensitivity. Feedback from beta test participants (n = 34) suggested that text messaging-based HIV prevention programming that is intense (e.g., 5-11 messages per day) and extends for two months, is both feasible and acceptable. In conclusion, the engagement of older adolescents at each step of the iterative intervention development process increased the likelihood that the final product would resonate with 18- to 22-year-old Ugandan youth across the country. Furthermore, social media appears to be a feasible method for recruiting national samples of Ugandan older adolescents into HIV-focused research.
在乌干达，针对大龄青少年的艾滋病毒预防规划明显不足，尽管艾滋病毒发病率从青少年期到青年期急剧上升。在这里，我们描述了 Together 项目（ITG）的开发过程，这是首个针对有性行为和禁欲的 18 至 22 岁乌干达青少年的综合性基于短信的艾滋病毒预防方案。描述了五个迭代开发活动：（1）进行焦点小组（FG），以更好地了解乌干达各地大龄青少年的性决策，并获得大龄青少年的“声音”；（2）根据 FG 数据起草干预内容；（3）由两个内容咨询小组（CAT）对草稿内容进行测试，CAT 对信息进行审查并提供反馈；（4）研究团队内部对方案进行 alpha 测试；（5）目标人群中的人员对干预措施和方案进行 beta 测试。参与者通过 Facebook 和 Instagram 在全国范围内招募，并由研究人员通过电话注册。结果表明，在所有干预措施的开发阶段，男性都更容易接触和参与。因此，专门做出努力招募女性，以确保考虑到来自两性的反馈。FG 参与者表示，他们有兴趣更多地了解性姿势、如何准备性行为、无保护性行为的后果、保护性行为的好处、自慰以及如何成为一个好的性伴侣。然而，在 FG（n=202）和 CAT（n=143）中，一些人指出，自慰、口交和肛交是特别敏感的话题。这些信息被重写以解决文化敏感性问题。来自 beta 测试参与者（n=34）的反馈表明，基于短信的艾滋病毒预防方案如果密集（例如，每天 5-11 条消息）并持续两个月，既可行又可接受。总之，在迭代干预开发过程的每一步都让大龄青少年参与，都增加了最终产品在全国范围内与 18-22 岁乌干达青年产生共鸣的可能性。此外，社交媒体似乎是招募乌干达大龄青少年参与艾滋病毒重点研究的全国性样本的可行方法。
