scholarly journals Thetha Nami : Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

2021 ◽  
Author(s):  
Maryam Shahmanesh ◽  
Nonhlanhla Okesola ◽  
Natsayi Chimbindi ◽  
Thembelihle Zuma ◽  
Nondumiso Mthiyane ◽  
...  
Keyword(s):  
South Africa ◽  
Health Promotion ◽  
Young People ◽  
Hiv Prevention ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Development ◽  
Participatory Development ◽  
Theory Of Change ◽  
Structured Interviews

Abstract Background: Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR) informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in rural KwaZulu-Natal (KZN). Methods: Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18-30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016-2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307).Results: Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me’). The intervention. included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components structured assessment tool to tailor health promotion and referrals; safe spaces and community advocacy to create an enabling environment; peer-mentorship and navigation of resources to improve retention in HIV prevention. Conclusion: Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

scholarly journals Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Shahmanesh ◽  
Nonhlanhla Okesola ◽  
Natsayi Chimbindi ◽  
Thembelihle Zuma ◽  
Sakhile Mdluli ◽  
...  
Keyword(s):  
South Africa ◽  
Health Promotion ◽  
Young People ◽  
Hiv Prevention ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Development ◽  
Participatory Development ◽  
Theory Of Change ◽  
Structured Interviews

Abstract Background Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN). Methods Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307). Results Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me’). The intervention included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components: structured assessment tool to tailor health promotion and referrals, safe spaces and community advocacy to create an enabling environment, and peer-mentorship and navigation of resources to improve retention in HIV prevention. Conclusion Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

scholarly journals Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

2020 ◽  
Author(s):  
Maryam Shahmanesh ◽  
Nonhlanhla Okesola ◽  
Natsayi Chimbindi ◽  
Thembelihle Zuma ◽  
Sakhile Mdl ◽  
...  
Keyword(s):  
South Africa ◽  
Health Promotion ◽  
Young People ◽  
Hiv Prevention ◽  
Sexual Health ◽  
Young Men ◽  
Theory Of Change ◽  
Hiv Care ◽  
High Morbidity ◽  
Men And Women

Abstract BackgroundDespite effective biomedical tools, adolescents and young men and women carry the dual burden of high HIV incidence and high morbidity/mortality in South Africa. We integrated community-based participatory research (CBPR) with biomedical interventions to develop a peer-led biosocial intervention for HIV care and prevention in young people living in rural KwaZulu-Natal (KZN).MethodsBetween March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected between 2016 and 2018 into 17 vignettes illustrating the local drivers of HIV. During two participatory intervention development workshops and community mapping, the peer-navigators discussed the vignettes in small groups, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change (ToC). Following a six-month pilot, the peer-navigators used process evaluation data and experience to refine the ToC in a third workshop.ResultsFollowing written and oral assessments 57 of the 108 initially selected participated in the two workshops to discuss the vignettes and co-create the Thetha Nami (talk to me) intervention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to include:· Structured assessment tool to tailor support.· Safe spaces and community advocacy to create an enabling environment for HIV prevention.· Peer-led sexual health promotion to improve self-efficacy and demand for HIV prevention.· Accessible youth-friendly clinical services to improve uptake of HIV prevention.· Peer-mentorship to navigate resources and improve retention in HIV prevention.ConclusionLocal youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention and care.

scholarly journals Co-Creating a Virtual Alcohol Prevention Simulation with Young People

2020 ◽  
Vol 17 (3) ◽  
pp. 1097 ◽  
Author(s):  
Lotte Vallentin-Holbech ◽  
Julie Dalgaard Guldager ◽  
Timo Dietrich ◽  
Sharyn Rundle-Thiele ◽  
Gunver Majgaard ◽  
...  
Keyword(s):  
Health Promotion ◽  
Young People ◽  
Self Efficacy ◽  
Intervention Development ◽  
Added Value ◽  
Knowledge Generation ◽  
Alcohol Prevention ◽  
Structured Interviews ◽  
Creation Process ◽  
Living Lab

Collaborative knowledge generation and involvement of users is known to improve health promotion intervention development, but research about the roles and perspectives of users in the co-creation process is sparse. This research aimed to study how young people perceived their involvement in a co-creation process focussed on the development of a gamified virtual reality (VR) simulation—VR FestLab. The Living Lab methodology was applied to structure and guide the co-creation process. Living Lab participants were comprised of students, health promotion practitioners, researchers, and film and gaming experts who collaboratively designed and created the content and structure of the VR FestLab. Semi-structured interviews were conducted with nine students who participated in the Living Lab and represented young end users. Interviews were tape-recorded, transcribed and thematically analysed. Students described that they had influence on their tasks. They felt included and expressed that the collaboration with and feedback from peers and other stakeholders increased their self-efficacy and empowered them to take ownership and generate new ideas. Participants voiced that they lacked information about the final production of VR FestLab. Co-creation guided by the Living Lab methodology produced added value in terms of empowerment and increased self-efficacy for the students involved. Future Living Labs should plan for communication with participants about further development and implementation processes following ideation and prototyping phase.

scholarly journals Development and initial validation of a simple tool to screen for partner support or opposition to HIV prevention product use

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242881
Author(s):  
Elizabeth E. Tolley ◽  
Seth Zissette ◽  
Andres Martinez ◽  
Thesla Palanee-Phillips ◽  
Florence Mathebula ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Partner Violence ◽  
Qualitative Data ◽  
Assessment Tool ◽  
Multiple Scales ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Male Partner ◽  
Partner Support ◽  
Initial Validation

In HIV prevention trials, male partners have influenced women’s ability to adhere to investigational products, including antiretroviral (ARV) containing vaginal rings. Validated scales can be useful tools to systematically measure complex constructs, such as those related to male partner engagement. Although multiple scales exist to assess physical, psychological and sexual violence within intimate relationships, fewer scales focus on supportive behaviors within these relationships. Our intervention involved development of a Healthy Relationship Assessment Tool (HEART) that assessed both positive and negative aspects of male partner involvement in women’s HIV prevention. We identified and refined 127 potential items, representing intimate partner violence, agency and social support. A structured survey, including potential items and other sociodemographic and behavioral variables was administered to former microbicide trial and non-trial participants. We conducted an exploratory factor analysis (EFA) to identify a reduced set of constructs and items to screen women who might experience social harms or benefits from vaginal ring use. We examined associations between constructs and with other survey variables to assess content and construct validity. In a subset of 10 women who participated in the survey and qualitative interviews, we used qualitative data to predict survey scores. We retained five constructs with theoretical relevance and good-to-strong reliability for the tool, including: Traditional Values; Partner Support; Partner Abuse & Control; Partner Resistance to HIV Prevention; and HIV Prevention Readiness. Predicted associations between HEART constructs, and correspondence between participants’ qualitative data and HEART scores were generally correct, while those between constructs and other sociodemographic variables were more mixed. Initial validation of the HEART tool was promising. The tool will be used during the CHARISMA pilot study at the Johannesburg MTN 025/HOPE site and validated as part of a randomized controlled trial of CHARISMA within a PrEP demonstration project. Beyond clinical trial settings, HEART could assist PrEP or antiretroviral treatment (ART) providers with an easy-to-administer tool to identify risk and tailor risk reduction, empowerment and adherence counseling for microbicides, PrEP or ART related services.

16. A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF EMAIL AND TEXT (SMS) MESSAGES ON THE SEXUAL HEALTH OF YOUNG PEOPLE

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 290 ◽  
Author(s):  
M. S. C. Lim ◽  
J. S. Hocking ◽  
C. K. Aitken ◽  
L. Jordan ◽  
C. K. Fairley ◽  
...  
Keyword(s):  
Health Promotion ◽  
Young People ◽  
Sexual Health ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Messages ◽  
Control Group ◽  
Sexual Risk Behaviour ◽  
Health Seeking ◽  
The Impact

Objective: To trial a novel method of sexual health promotion - sending email and mobile phone text messages (SMS) about safe sex and STI to promote reductions in STI behaviours and increases in STI knowledge and testing. Methods: Young people (aged 16-29) were recruited at a music festival in Melbourne. They completed a questionnaire about sexual risk behaviour and were randomised to either the intervention arm of the study (to receive messages) or a control group. Text messages were sent every 3-4 weeks for a twelve month period and included catchy STI prevention slogans. Emails were sent monthly and contained detailed information about STI topics and links to related websites. Participants completed follow-up questionnaires online after 3, 6 and 12 months. Clustered weighted estimating equations were used to compare outcomes of the two groups. Results: 994 people completed at least one questionnaire (507 in the intervention group and 487 in the control group); at baseline 58% were female, the median age was 19 years and 82% had ever had sex. At 12 months, STI knowledge was higher among the intervention group for both males (OR 3.19, 95% CI 1.52, 6.69) and females (OR 2.36, 95% CI 1.27, 4.37). Females in the intervention group were also more likely to have discussed sexual health with a clinician (OR 2.92, 95% CI 1.66, 5.15) and to have had an STI test in the past 6 months (OR 2.51, 95% CI 1.11, 5.69). There were no significant differences in condom use between the groups. Respondents' opinions of the SMS and emails were positive. Conclusions: Receiving regular sexual health-related SMS and email messages can improve knowledge in young people and health seeking behaviour in young women. SMS and email are low cost, widely available and convenient, which - when combined with their popularity among youth - means that these media have considerable potential for sexual health promotion.

scholarly journals Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ilene S. Speizer ◽  
Mahua Mandal ◽  
Khou Xiong ◽  
Ndinda Makina ◽  
Aiko Hattori ◽  
...  
Keyword(s):  
South Africa ◽  
Young People ◽  
Hiv Prevention ◽  
Longitudinal Data ◽  
Condom Use ◽  
Genital Herpes ◽  
Life Orientation ◽  
School Based ◽  
Kwazulu Natal ◽  
And Control

Abstract Background Young people under age 25 years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17 years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes. Methods This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education’s revised scripted lesson plans for the HIV and sexual content of a “life orientation” curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use). Results At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6 years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort. Conclusions We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation. Trial Registration: This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.

A Researcher–Practitioner Collaboration to Enable Replication of an Evidence-Based Financial Education and Coaching Program That Improves Health in Low-Income Single Mothers

2021 ◽  
pp. 152483992110654
Author(s):  
Danielle Galvin ◽  
Julie Kalkowski
Keyword(s):  
Low Income ◽  
Controlled Trial ◽  
Financial Education ◽  
Well Being ◽  
Social Determinant ◽  
Theory Of Change ◽  
Financial Strain ◽  
Structured Interviews ◽  
Health Related ◽  
Core Components

Financial strain is a social determinant of health (SDOH). Although public financial education helps individuals improve financial well-being, specifics are lacking on how and why effective programs work, potentially limiting their successful replication in other practice settings. In this study, researchers and practitioners cocreated the core components and theory of change of a novel financial education and coaching program, which a randomized controlled trial found was effective in significantly improving participants’ financial and health-related behaviors. A Cocreating Knowledge Translation Framework within a case study design was used at a university-affiliated nonprofit in Omaha, Nebraska, from August to December 2020. Twelve practitioner and alumni participants were purposefully sampled. An administrative records review, semi-structured interviews (n =3), survey (n = 10), and facilitated backward mapping session (n = 5) were conducted. Transcripts were coded to identify themes. Thirty-one core components were identified within program principles, design, tools, activities, and expectations of participants and coaches. Ten theory of change outcomes described participants’ pathway to change. Interventions occurred at individual, relationship, and community levels from initial engagement, through behavioral changes, to improved health-related quality of life. Activities and indicators were mapped to each outcome. The program’s intersecting and reinforcing design was key to enabling participants’ outcomes. Its theory of change described how and why the model improved financial and health behaviors. Findings suggest that other SDOH-focused organizations may benefit from researcher–practitioner collaboration to investigate their interventions’ core components and theories of change. This may enable replication, promoting downstream health benefits in new community settings.

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

2020 ◽  
Author(s):  
Natsayi Chimbindi ◽  
Nondumiso Mthiyane ◽  
Thembelihle Zuma ◽  
Kathy Baisley ◽  
Deenan Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Young People ◽  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Community Members ◽  
Long Distance ◽  
Female Sex ◽  
Kwazulu Natal ◽  
Prep Awareness

Abstract Introduction: Pre-exposure prophylaxis (PrEP) has the potential to alter the HIV epidemic in South Africa. Between 2016 and 2018 PrEP was rolled-out for 18-24 year-old female-sex workers (FSW) in a rural KwaZulu-Natal subdistrict with very high HIV incidence among adolescent girls and young women (AGYW). Using a ‘framework of access’ model, we describe PrEP access, awareness and uptake for AGYW, including community members’ attitudes towards PrEP for young people.Methods: We enrolled a cohort of 2184 AGYW aged 13-22 living within the subdistrict and quantitatively measured their eligibility, awareness and uptake of PrEP and other HIV prevention interventions in 2017 and 2018. We supplemented this insight with in depth exploration by conducting 19 group discussions with young people and community members, nine stakeholder key informant interviews, 58 in-depth interviews with 15-24 year-olds and 33 with implementing partners, and participatory observations. All interviews were recorded, transcribed and analysed using thematic analysis.Results: PrEP awareness increased from 2% to 9% from 2017 to 2018. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4-15.7%) reported transactional sex and 10.6% (95%CI: 8.8-12.7%) sex for money. Of these latter 194 PrEP-eligible AGYW, 21 were aware of PrEP, but none had ever used it. Wider community members were generally unaware of PrEP but imagined it would benefit young people, HIV-serodiscordant couples and those in long-distance relationships. Youth saw PrEP as a positive alternative to condoms since it “will be in their system” and not get in the way of sex. Teachers and healthcare providers were more apprehensive: worrying that PrEP would lower personal responsibility for sexual health.Conclusions: Although PrEP awareness increased and it was generally acceptable, uptake was low even among eligible AGYW, i.e., who reported FSW activity. Condom use remained undesirable suggesting a need to include PrEP in offers of alternative HIV prevention technologies to comdoms. The targeted nature of public-sector PrEP for FSW may have limited the reach, and the future broader roll-out, of PrEP in this setting. Inclusive approaches to PrEP provision integrated with wider sexual healthmay help improve demand and access to PrEP.

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