# Development of a digital intervention to address stigma among pregnant unmarried adolescents living with HIV

> **NIH NIH R21** · PACIFIC INSTITUTE FOR RES AND EVALUATION · 2022 · $214,393

## Abstract

Project Summary/Abstract
Kenya is one of few countries burdened by a combination of high rates of mother-to-child transmission (MTCT)
of HIV, large numbers of adolescents living with HIV (ALHIV), and elevated adolescent fertility rates. Pregnant
ALHIV are less likely than adults to attend antenatal care clinics and to receive prevention of MTCT (PMTCT)
services, thereby contributing to the high MTCT rate. Previous work among 15-19-year-old Kenyan ALHIV,
including some who were pregnant, found that stigma, undisclosed HIV status, and lack of social support may
be key barriers to engagement in PMTCT services. Thus, addressing barriers to disclosure and social support
may mitigate harmful effects of the intersecting stigmas of HIV and pregnancy on health outcomes. Although
mixed, study findings suggest that mHealth interventions that use text messaging (SMS) may improve PMTCT
outcomes. They are, however, limited in their ability to facilitate behavior change via support mechanisms or
skill development. Growing evidence highlights the promise of digital interventions as important tools for
improving HIV outcomes and communication with parents. However, digital interventions to address the effects
of stigma have not been explored among pregnant ALHIV. This study will build on previous work and draw on
an integrated conceptual framework to develop and evaluate a digital intervention for pregnant unmarried
ALHIV. The intervention will include SMS for reminder purposes and web-based virtual simulations, gamified
elements, and didactic content to educate and build relevant stigma-related skills. Acceptable approaches will
be identified to involve family caregivers in addressing the detrimental effects of the intersecting stigmas on
pregnant ALHIV. Family caregivers are an important yet underappreciated and understudied source of social
support for pregnant unmarried ALHIV. Together, these are expected to improve engagement in PMTCT
services among pregnant ALHIV. The study specific aims are to: (1) Develop and evaluate a digital intervention
for pregnant unmarried ALHIV aged 15-19 to increase awareness of stigma and its consequences; improve
disclosure self-efficacy and skills; and facilitate enlistment of family caregivers as social support allies to
enhance uptake of PMTCT services; and (2) Identify acceptable approaches to increase awareness about
stigma and enhance skills in communication and provision of social support among family caregivers. We will
use data from individual interviews with pregnant ALHIV and joint interviews with pregnant ALHIV/caregiver
dyads to develop initial intervention specifications and mock-ups. We will then conduct focus group to obtain
feedback on sample materials in order to refine the materials and develop an intervention prototype. We will
then conduct a pilot to evaluate acceptability, usability, and preliminary efficacy of the prototype. We will
conduct focus groups with caregivers to identify acceptable approaches to...

## Key facts

- **NIH application ID:** 10488666
- **Project number:** 5R21TW011788-02
- **Recipient organization:** PACIFIC INSTITUTE FOR RES AND EVALUATION
- **Principal Investigator:** Winfred K Luseno
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $214,393
- **Award type:** 5
- **Project period:** 2021-09-17 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10488666

## Citation

> US National Institutes of Health, RePORTER application 10488666, Development of a digital intervention to address stigma among pregnant unmarried adolescents living with HIV (5R21TW011788-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10488666. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*