A Mobile Health Intervention to Increase Uptake of PrEP and Contraception Among Female University Students in Zambia

HIV infection and unintended pregnancy are highly prevalent, life-altering events among adolescent girls and young women in low- and middle-income countries. Due to a number of biological, social, and structural factors, adolescent girls and young women in sub-Saharan Africa remain a sub-population highly susceptible to HIV infection. Further, the majority of pregnancies among adolescent girls and young women occur in low- and middle-income countries with the highest rates found in sub-Saharan Africa. In Zambia, female university students are a neglected, high-risk sub-population for both HIV infection and unintended pregnancy. Oral pre- exposure prophylaxis and modern contraception are key biomedical prevention tools but increasing the uptake among young women in sub-Saharan Africa has proven challenging. Based on preliminary research, we propose to design a novel peer navigator pre-exposure prophylaxis/contraception mobile health intervention targeting high-risk female university students in Zambia. The peer-navigator intervention will be facilitated by a tablet-based platform to assess HIV and unintended pregnancy risk, provide education and information, link high-risk young women to sexual and reproductive services, assess preferences for peer support, track the use of health services, and provide ongoing support for pre-exposure prophylaxis and contraception uptake and persistence through regular communication. Using a mixed methods phased approach guided by integrated behavioral and mobile health theories, we will first adapt an existing mobile application using Human-Centered Design and qualitative methods to create a new tablet-based application to serve as a platform for peer navigators to promote and track pre-exposure prophylaxis and contraception use among high-risk female students (Aim 1, R21 phase). After several iterations have been evaluated by stakeholders, we will test the application and peer-navigator intervention package in a small prospective single-arm trial, collecting data on the functionality of the application and the acceptably/appropriateness of the peer-navigator intervention (Aim 2, R21 phase). After refining the application and intervention package, we will then thoroughly test the mHealth intervention through a single-site hybrid type 1 effectiveness-implementation randomized controlled trial to 1) determine the effectiveness of the intervention to increase pre-exposure prophylaxis and modern contraceptive use, 2) establish underlying behavioral mechanisms, and 3) evaluate implementation-related factors that will enhance the likelihood for the intervention to be implemented, sustained, and scaled (Aim 3, R33 phase). If proven effective, the peer- navigator mobile health intervention will provide a scalable model to fill-in persistent gaps in HIV prevention and reproductive health among young women in high HIV prevalence low- and middle-income country settings.