Evolving strategies, opportunistic implementation: HIV risk reduction in Tanzania in the context of an incentive-based HIV prevention intervention.
Evolving strategies, opportunistic implementation: HIV risk reduction in Tanzania in the context of an incentive-based HIV prevention intervention.
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DOI：
10.1371/journal.pone.0044058
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Mtenga S
中科院分区：
文献类型：
--
作者：
Packel L;Keller A;Dow WH;de Walque D;Nathan R;Mtenga S
行为改变交流（BCC）干预措施虽然仍然是艾滋病预防的必要组成部分，但仅凭其自身已被证明不足以遏制这一流行病的蔓延。BCC干预措施的缺陷部分是由于结构或经济限制所产生的障碍。有人主张采用综合预防方案，包括行为改变、生物医学和结构干预措施，以应对可能导致艾滋病感染的一系列复杂风险因素。
2009年至2010年，我们对参与RESPECT研究的一部分研究对象进行了216次深度访谈。RESPECT研究是在坦桑尼亚进行的一项艾滋病预防试验，该试验利用现金奖励来激励更安全的性行为。我们分析了社区日志，以了解社区对该研究的看法。我们利用这些数据来加深对干预措施如何影响降低风险策略的理解。
我们发现某些情况为性协商提供了更大的影响力，并且这些情况促进了降低风险策略的机会性实施。RESPECT干预措施所带来的机会包括利用有条件的现金奖励，但参与者也强调了利用定期性传播感染检测所获得的新健康状况知识的重要性。降低风险的策略包括在伴侣关系内和/或与其他伴侣使用避孕套，以及意外地强调暂时禁欲。
我们的研究结果强调了增加实施降低风险策略机会的重要性。我们发现，基于激励的干预措施能够部分地通过创造此类机会而有效，特别是在性自主权有限的女性等群体中。研究结果提供了新的证据，表明扩大性传播感染的定期检测是为行为改变协商提供机会的另一个重要机制，这超出了检测的直接益处。作为创新性的艾滋病综合预防新干预措施的一部分，挖掘对性传播感染检测的潜在需求应受到重新关注。
Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection. In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction. We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence. Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.
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影响因子：
2.9
作者：
de Walque D;Dow WH;Nathan R;Abdul R;Abilahi F;Gong E;Isdahl Z;Jamison J;Jullu B;Krishnan S;Majura A;Miguel E;Moncada J;Mtenga S;Mwanyangala MA;Packel L;Schachter J;Shirima K;Medlin CA
通讯作者：
Medlin CA
DOI：
10.1097/01.aids.0000390704.35642.47
发表时间：
2010-10
期刊：
AIDS (London, England)
影响因子：
--
作者：
Hayes R;Watson-Jones D;Celum C;van de Wijgert J;Wasserheit J
通讯作者：
Wasserheit J
影响因子：
15.8
作者：
London AJ;Borasky DA Jr;Bhan A;Ethics Working Group of the HIV Prevention Trials Network
通讯作者：
Ethics Working Group of the HIV Prevention Trials Network
影响因子：
5.4
作者：
Chimbiri, Agnes M.
通讯作者：
Chimbiri, Agnes M.
DOI：
10.1196/annals.1425.013
发表时间：
2008-01-01
期刊：
REDUCING THE IMPACT OF POVERTY ON HEALTH AND HUMAN DEVELOPMENT: SCIENTIFIC APPROACHES
影响因子：
--
作者：
Krishnan, Suneeta;Dunbar, Megan S.;Padian, Nancy S.
通讯作者：
Padian, Nancy S.