Posts classified under: Global Impact

Angola – Acceptability of Handheld Computers to Collect Self-reported Sexual Behavior Data in Angola

Acceptability of Handheld Computers to Collect Self-reported Sexual Behavior Data in Angola

This study evaluates the cultural acceptability and cost-effectiveness of using handheld computers to collect sexual behavior data, in order to reduce disparities in access to HIV/AIDS prevention and care services in Angola, a country severely impacted by HIV/AIDS. Specifically, this study aimed 1) to assess how comfortable Angolans feel in disclosing sexual behavior in handheld computer surveys compared to paper surveys, and 2) to assess how comfortable Angolan interviewers feel in administering handheld computer surveys vs. paper surveys.

Targeted Risk Group: 

Sexually active adults, 18-45

Intervention model: 

Randomized Control Trial

Research Methods: 

We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior. Participants were asked about their HIV/AIDS-related knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition.

International Significance: 

Handheld computers have potential to improve HIV/AIDS programs in healthcare settings in low-income countries, by improving the speed and accuracy of collecting data. However, the acceptability of the technology (i.e., user attitude and reaction) is critical for its successful implementation. Acceptability is particularly critical for HIV/AIDS behavioral data, as it depends on respondents giving accurate information about a highly sensitive topic – sexual behavior. These results suggest that using handheld computers in data collection in Angola may lead to biased reports of HIV/AIDS-related risk behaviors.

Popular Opinion Leader HIV Intervention among Chinese Market Workers

This project is part of the NIMH Collaborative HIV/STD Prevention Trial which adopts a two-arm, randomized community-level design to test the Popular Opinion Leader (POL) HIV prevention intervention model at five international sites (China, India, Peru, Russia, and Zimbabwe). CCH is the lead on the China site.

China, representing 1/4th of the world’s population, has a rapidly emerging HIV epidemic with about 1.2 million individuals already infected, more than the total of all the Asian nations combined. Similar to Africa and India, the country’s 200-250 million labor migrants are a key to the epidemic’s future; however, HIV infection is predominantly occurring in rural settings (75% of population) and migrants transmit the virus heterosexually when moving to the cities annually.

The goals of this project are: 1) to adapt a comprehensive community-level preventive intervention – The Popular Opinion Leader – to populations in China based on data from ethnographic studies and compare the results with the other four international sites which follow the same research procedure; 2) to test the efficacy of this community-level preventive intervention in China as well as the four international sites utilizing both behavioral and biological outcomes; and, 3) to develop a manual that will permit different health care agencies and service providers to conduct rapid ethnographic studies, translate this community-level intervention to different settings and populations, and assess intervention efficacy.

The ability of CCH investigators to successfully implement the project is based on previous successful HIV prevention trials including interventions in China and participation in HIV-related cooperative agreements; support of the project from experienced Chinese collaborators, officials, and organizations; access to sites in China; collaboration with experienced Chinese investigators, several of whom have trained at UCLA; collaboration of the Qualitative Core of the UCLA-NPI with considerable cross-national and cross-site experience; and previous experience in conducting interventions and assessments that are culturally sensitive and appropriate.

Family-Focused HIV Disclosure Intervention in Thailand

This is a Mentored Research Scientist Development Award (K01). HIV disclosure is a key stressor among HIV-affected families in Thailand, and the impact radiates throughout the family. By addressing HIV disclosure as a family matter, the proposed study aims to develop and pilot a culturally tailored intervention in Northeastern Thailand in Nakhon Ratchasima Province.

In Phase 1, formative research will be conducted using in-depth interviews with 20 People Living with HIV (PLH), 20 family members, and 10 healthcare providers to explore the concerns, barriers and motivators around HIV disclosure.  In Phase 2, we will develop a culturally tailored HIV disclosure intervention by engaging 20 PLH through a series of focus groups.  In Phase 3, we will pilot test the intervention with 40 PLH and compare their physical, psychological and social outcomes with the outcomes of 40 PLH in the standard care group. Follow-up assessments with PLH will be conducted at 6 months.

 

Mamekhaya

In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).
Research Methods:
HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.
Local Significance: 
Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

Nsindikanjake Vocational Training Project

Socio-economic status plays an important role in HIV risk and prevention. Specifically, poverty can lead to survival sex and unprotected sex. The Nsindikanjake Vocational Training Project, a collaboration between UCLA and the Uganda Youth Development League (UYDEL), aims to reduce HIV risk among urban Ugandan youth through vocational education and training.

From February 2005 to January 2006, 100 13- to 23-year-old participants were recruited from two different youth centers in the slums of Kampala, Uganda. Youth were randomized by site to an immediate vocational training intervention (N=50 youth) or a 4-month delayed vocational training (N=50 youth). Participants were assessed at baseline, 4, and 24 months later. Youth were asked about employment, sexual risk behaviors, delinquent behavior, quality of life, mental health symptoms, and drug use.Vocational education consisted of apprenticeships with local artisans for 4 to 8 hours, 5 days a week. Artisans received training in having conversations with youth about HIV and how to cope with unprofessional behavior (e.g., tardiness, hygiene problems). Youth in the delayed training condition received vocational training after a 4-month follow-up assessment was completed. The final assessment was administered 24 months after enrollment, by which time all youth had received training.
Vocational training may be highly useful in supporting the impact of HIV prevention. The participants receiving vocational training showed reduced delinquent behaviors and greater improvements in employment, life satisfaction, and social support compared to control participants. Both conditions demonstrated such improvements at two years, especially ongoing employment which remained strong.

Project i (Prevention Among Homeless Youth)

A number of studies have informed us about the substantial risk for HIV associated with chronic homelessness among youth in both the U.S. and Australia, even though these studies have typically been cross-sectional or samples of convenience. To understand the high seroprevalence rates among older homeless youth, the developmental trajectories into and out of risk for HIV and homelessness can best be understood from longitudinal studies of first time runaways, in which contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time.

The National Institute of Mental Health (NIMH) funds this study of new homeless young people. The purpose of the study is to understand the life course of new homeless youth and runaways. The study focuses on the many sources that are influencing youths pathways into and out of homelessness and risk for HIV, such as a youth’s family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems.

PROJECT i is following new homeless youth over time to see if they become more similar or dissimilar to experienced homeless youth. We know that among homeless youth, remaining homeless may only serve to increase their risk for HIV. This suggests a critical need to find ways to divert new homeless youth from the path of chronic homelessness and greater risk for HIV infection. The results of the study will be used to design interventions for new homeless youth to reduce their risk for HIV and to help inform service providers who may influence the life course of runaways and homeless youth and as a result help decrease their risk for HIV and becoming chronically homeless.

Approximately 240 youth, ages 12 to 20 years, are being recruited throughout various parts of Los Angeles County. A similar sample is being recruited in Melbourne, Australia. Youth who report having left home no more 180 days are eligible to participate in the study. An additional 200 youth per year, ages 12 to 20 years, who report having left the home for more than 180 days and who do not meet the above criteria, are eligible to participate in a one-time interview as part of a comparison group.

Following a baseline interview, study participants are interviewed at three months and then every six months for a total of eight interviews over a three-year period. Interviews take approximately one hour to complete. The baseline interview is conducted at the shelter or center where the youth was recruited. Follow-up interviews are conducted at a place convenient for the youth.

China Stigma Project

China has 1 million Persons Living with HIV (PLH) and will have an anticipated 10 million PLH by the year 2010. With 1/5 of the world’s population (1.4 billion persons) in China, the risk of an epidemic is substantial. Recently, the Chinese government has recognized the substantial risk it faces in HIV and has allocated resources to fight HIV. Yet HIV-related stigma and discrimination continue to impede every step in mounting an effective response for prevention, treatment, and care in China.

The National Institute of Mental Health funds this 3-year project of HIV/AIDS-related stigma among health care providers in China. The specific aims of this project are: To document base rates of HIV related stigma among service providers and health administrators and its impact on health service behaviors and care for PLH; To identify socio-cultural, structural, and personal factors that are associated with HIV-related stigma towards PLH among service providers and health administrators; and To design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.

A total of 105 participants have taken part in the in-depth qualitative interview in Phase I study. Among them 30 are PLH, 15 are family members of PLH, 33 are health care providers, and 27 are health care administrators. Approximately 1,000-1,400 health care providers are being recruited to participate in Phase II quantitative survey study. Using data collected from Phases I and II, the research team will design and pilot test an intervention aimed at reducing HIV/AIDS-related stigma among health care providers in China.

Geographical location:

Yunnan Province,China

Targeted group:

Service providers working at the provincial, city, county, township and village level medical facilities.

Intervention model:

Psych-education and planned behavioral change

 Research methods:

  • In-depth qualitative interviews with PLH, family member of PLH, service providers, and health administrators.
  • A survey of 1,001 service providers and health administrators
  • Intervention pilot with baseline, 3-month and 6-month follow-ups.

Published Journal Articles :

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China Provider Project

China has one-fifth of the world’s population (1.4 billion people); the risk of an HIV pandemic is substantial. In 2005, AIDS surpassed hepatitis B to become the third deadliest infectious disease in China in 2005. The Chinese government has implemented a national program, “Four Frees and One Care,” which mandates access to free HIV testing and free anti-retroviral (ARV) treatment to AIDS patients in China.

As the demand for HIV treatment and care increases rapidly, service providers in China are at a critical point with growing responsibilities to deliver adequate services and care for patients living with HIV/AIDS (PLH). However, experiences of unwelcoming treatment often discourage PLH from seeking care from providers who exhibit discriminatory attitudes and behaviors. HIV-related stigma has a tremendous impact on PLH’s health outcomes, health seeking behavior, and treatment adherence. Only when patients’ fears of discrimination are reduced will they be more willing to participate in HIV testing and treatment.

The National Institute of Mental Health funds this four-year randomized controlled trial that addresses both individual and structural components to reduce HIV-related stigma among service providers in China. This intervention trial builds on a three-year pilot study that we conducted among 1,344 service providers in China from 2003 to 2006. From the pilot, we recognized the need to address HIV-related stigma by building social norms of acceptance and focusing on the well-being of all patients as well as service providers. This Popular Opinion Leader [POL] and access to universal precautions intervention integrates the behavioral level with the structural level and incorporates all core elements of the POL model with four training sessions and bi-monthly reunion sessions. We plan to train 600 POL providers in 40 county hospitals in Yunnan and Fujian, China.

The intervention trial will proceed in two phases. In Phase 1, we will develop and finalize the intervention, assessment instruments and implementation procedures. In Phase 2, we will randomly assign 40 hospitals to either: 1) an intervention group, or 2) a standard care group. The impact of the proposed intervention will be assessed over 12 months (baseline, 6 & 12 months), with 1,760 service providers and 1,000 patients. The provider outcomes are providers’ attitude and behavior changes toward patients and their universal precaution practice. The patient outcomes are patients’ perceived stigma, medical service utilization, and satisfaction and treatment adherence.

Published Journal Articles :

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Masihambisane – Pregnant Women: KZN

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Since clinics are the typical sites for treating each of these health problems, the NIMH-funded Masihambisane study is examining a clinic-based prevention program delivered by neighborhood Mentor Mothers (MM) to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group: 

Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles :

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Interventions, Training Manuals, etc. :  

Surveys and Scales Used: 

Intervention model:  
In the intervention arm, participants will receive the Department of Health-delivered Prevention of Mother to Child Transmission (PMTCT) program plus the Project Masihambisane mentor mothers support program, delivered by HIV-positive mentor mothers. HIV-positive mentor mothers are women who are thriving in the community and who have been through the PMTCT program. They have been recruited and trained to deliver the intervention to pregnant mothers living with HIV.

Research Methods: 

Eight clinics were randomly assigned to the intervention (4 clinics) or control condition (4 clinics). There are two levels of nesting in the study. Mothers and their infants are nested within clinics, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

International Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

Street Smart Uganda; UYDEL

Targeted Risk Group: 

Urban Ugandan youth (UYDEL)

Street Smart was an intensive HIV/AIDS program for slum youths whose behaviors place them at risk of becoming HIV infected. It was implemented in collaboration with Uganda Youth Development Link.

Based on the fact that adolescence is a time of experimentation and developmental change in behavior, thoughts and emotions, Street Smart linked feelings, thoughts, emotions and attitudes to behavior change.

In 2007, nearly 1 million young people became infected with HIV in sub-Saharan Africa. Existing prevention programs have not been effective, prompting more attention toward the social determinants of HIV, such as unemployment. Without hope for the future, it is unlikely that young people will be motivated to remain free of HIV, as poverty creates vulnerability to survival sex or sex without condoms. The Street Smart intervention was developed in the United States to eliminate or reduce HIV risk behaviors among young people. Despite its success, it does not address the problems of economic vulnerability and investment in the future. The aim of this study was to test the added value of vocational training provided to urban Ugandan youth, in addition to the Street Smart HIV prevention program.

Download the UYDEL 2010 brochure here:  Uganda Youth Development Link (UYDEL) (2010) - Brochure

Interventions, Training Manuals, etc. : 

  1. Street Smart Introduction
  2. Street Smart Session 1: Language of HIV and STDs
  3. Street Smart Session 2: Personalized Risk
  4. Street Smart Session 3: How to Use Condoms
  5. Street Smart Session 4: Drugs and Alcohol
  6. Street Smart Session 5: Recognizing and Coping with Feelings
  7. Street Smart Session 6: Negotiating Effectively
  8. Street Smart Session 7: Self Talk
  9. Street Smart Session 8: Safer Sex
  10. Street Smart Session 9: Personal Counseling
  11. Street Smart: Table of Contents - Sessions 1-10

Intervention model: 

Street Smart consists of a total of 10 sessions (eight two- hour group sessions, one individual session and a group visits to a community health resource), exposes youth to information regarding HIV/AIDS, drug abuse, condom use, personalized risks, negotiating safer sex, recognizing and coping with feelings and self talk. Intervention sessions included participatory discussions, role-plays & use of tokens. Participants were divided into groups consisting of 8 to 9 members per group. Each group attended 3 sessions a week, each session lasting an average of 2hrs and 30 minutes.

Research Methods:

The project included a total of 50 street and slum youth from two slum centers in Kampala. Participants completed a behavioral assessment at baseline and at 4-months. Twenty-five participants from one slum center initially served as the control group and received the intervention after their 4-month follow-up assessment. Twenty-five participants from the second slum center received the 10-session HIV prevention intervention immediately following their Baseline assessment.

Local Significance: 

A total of 24 participants (96%) completed the entire 10 session intervention. The youth were also linked to important support services available to them. Given the small sample size and limited statistical power, longitudinal hierarchical linear models to examine the efficacy of the intervention were not appropriate. However, feedback gathered from both the youth participants and research staff, the intervention was very well-received. The youth’s engagement in the intervention is also apparent in the extremely high completion rate of the intervention.

International Significance: 

There were two primary objectives to the collaboration with Uganda Youth Development. The first objective was to build the research capacity and skills among the team of Uganda collaborators. During the course of the project, the UCLA team conducted non-formal and formal training activities in Uganda. The second objective was to adapt, implement, and evaluate the efficacy of the adapted HIV prevention intervention with street and slum urban youth in Kampala, Uganda. This was accomplished through the collaborative effort of the UCLA researchers and the Uganda research team.

The Street Smart intervention continues to be implemented by the staff at UYDEL, demonstrating the staff support and commitment to the intervention and the work completed through the research. Mr. Rogers Kasirye has consulted with other Ugandan agencies regarding the development of interventions and research with street and slum youth in Uganda.

Despite some study limitations, the results suggest that at 4 months the vocational training program improved employment, satisfaction with life, and social support; and reduced delinquent behaviors. Vocational training plus Street Smart improved social support and reduced sexual risk-taking, delinquent behavior, and substance use at 2 years. Fewer than half had ever worked prior to the program, but over 80% were employed at 2 years. Larger trials of HIV interventions addressing social determinants are warranted.

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