ICAP, Columbia University, New York, New York, USA
Department of Population and Family Health, Columbia University, New York, New York, USA.
BMJ Open. 2024 Nov 14;14(11):e090686. doi: 10.1136/bmjopen-2024-090686.
By 2030, an estimated 42% of the world's adolescent girls and young women (AGYW) will live in sub-Saharan Africa (SSA), where a quarter of AGYW pregnancies are undesired and AGYW represent 75% of new HIV infections. Most AGYW in SSA use short-acting contraceptive methods, including many who rely solely on condoms, which results in variable patterns of protection against undesired pregnancies and HIV. Dynamics of contraceptive use and HIV prevention efforts are poorly understood but the DYnamics of Contraception in Eswatini study will contribute to the understanding of the complex relationship between sexual behaviours, risk perception and HIV and pregnancy prevention.
All AGYW 18-24 years who participated in a 2021 nationally representative, population-based (face-to-face) HIV survey, consented to future research and provided a mobile phone number will be contacted for enrolment. Consenting AGYW will complete a baseline questionnaire and be surveyed biweekly for 2 years. The three objectives of the study are to (1) investigate how changing individual context (schooling, income, residential mobility) impact contraceptive use; (2) examine the relationship between pregnancy desires and contraceptive use and (3) test whether changes in a woman's perception of her HIV risk changes her probability of contraceptive use and HIV protective behaviours. Data collection will take place from March 2024 to March 2026 via computer-assisted telephone interviews. During recruitment (March-April 2024), two interviewers called 794 AGYW, of whom 326 completed the baseline questionnaire (41%) and 321 consented to biweekly follow-up (40% American Association for Public Opinion Research response rate #1). Analyses will mainly use hybrid within-between logistic regression models.
This protocol was reviewed and approved by the Eswatini National Health Research Review Board in 2024 and Columbia University Medical Center Institutional Review Board in 2023. Findings from the study will inform the Eswatini Ministry of Health approaches to mitigating undesired pregnancies and HIV among AGYW. Second, few examples exist of high-frequency longitudinal data collection in SSA, and this study will contribute to the survey method knowledge. Finally, the rich dataset will available for secondary data analysis.
到 2030 年，预计世界上 42%的少女和年轻女性（AGYW）将居住在撒哈拉以南非洲（SSA），其中四分之一的 AGYW 怀孕是不想要的，而 AGYW 占新感染 HIV 的人数的 75%。SSA 的大多数 AGYW 使用短效避孕方法，其中许多人仅依赖避孕套，这导致避孕和预防 HIV 的效果不稳定。避孕方法的使用和 HIV 预防措施的动态尚不清楚，但斯威士兰避孕动态研究将有助于了解性行为、风险认知与 HIV 和妊娠预防之间的复杂关系。
所有在 2021 年参加全国代表性、基于人群（面对面）HIV 调查且同意参与未来研究并提供手机号码的 18-24 岁 AGYW 将被联系入组。同意入组的 AGYW 将完成基线问卷，并在接下来的 2 年内每两周接受一次调查。该研究的三个目标是：（1）调查个人环境（教育、收入、居住流动性）变化如何影响避孕方法的使用；（2）研究怀孕意愿与避孕方法的关系；（3）检验女性对 HIV 风险认知的变化是否会改变其使用避孕方法和预防 HIV 的行为的可能性。数据收集将于 2024 年 3 月至 2026 年 3 月通过计算机辅助电话访谈进行。在招募期间（2024 年 3 月至 4 月），两名访谈员致电 794 名 AGYW，其中 326 人完成了基线问卷（41%），321 人同意进行两周一次的随访（40%符合美国民意研究协会的回复率 #1）。分析主要使用混合的个体内-个体间逻辑回归模型。
本方案于 2024 年经斯威士兰国家卫生研究审查委员会和 2023 年经哥伦比亚大学医学中心机构审查委员会审查和批准。该研究的结果将为斯威士兰卫生部提供方法信息，以减少少女和年轻女性中的意外怀孕和 HIV。其次，在 SSA 中很少有高频纵向数据收集的例子，本研究将有助于提高调查方法的知识。最后，该丰富的数据集将可用于二次数据分析。
