Mobilizing Health Workers/Community HIV Prevention/Chile

描述（由申请人提供）：拟议的艾滋病-FIRCA研究将适应，实施和测试同伴群体干预，以动员智利卫生工作者作为艾滋病毒/艾滋病预防领导人。该干预措施首先在博茨瓦纳开发，然后在马拉维适用于学校教师，现在正在用于培训马拉维的卫生工作者、社区成年人和青少年。卫生工作者是控制艾滋病毒/艾滋病流行病斗争取得成功的关键。智利的艾滋病流行病刚刚开始，但这种流行病现在正在向一般人口蔓延，超出了传统的高危群体。现在，很少有努力是针对控制这一流行病或培养保健工作者在预防艾滋病毒方面发挥作用。这种动员卫生工作者的同侪小组领导人培训模式成本低，可持续，对智利和拉丁美洲区域具有高度相关性。智利的研究将部分复制马拉维的研究。在第一阶段，通过重点小组和与卫生行政人员和工作人员的访谈进行形成性评估，将使我们能够为智利的卫生工作者量身定制干预和评估工具。在五个干预诊所和五个可比较的对照诊所的卫生工作者和客户的测试前和测试后的观察准实验将评估干预的效果。过程评价将记录干预的质量。在五个干预和五个延迟干预对照诊所中，对干预前后的卫生工作者进行的卫生工作者-客户观察和访谈，将使我们能够在干预后三个月内检验有关卫生服务和卫生工作者变化的假设。保健服务成果包括：普遍预防措施的一贯做法，对艾滋病毒相关问题表现出敏感性，并纳入艾滋病毒预防信息。卫生工作者的成果包括：艾滋病毒/艾滋病知识增加，对艾滋病毒/艾滋病感染者和艾滋病毒预防的态度更加积极，在工作和个人生活中预防艾滋病毒的行为增加。功效分析表明，每个诊所457名工作人员的样本，参与率为80%，足以在0.80的功效下检验小到中等的预期效应。研究结果将分发给卫生工作者和决策者。四名智利共同调查员的充分参与和美国小组的讲习班将建设东道机构的研究能力。这一干预措施是在全国动员保健工作者预防艾滋病毒的低成本可持续模式。

DESCRIPTION (provided by applicant): The proposed AIDS-FIRCA research will adapt, implement, and test a peer group intervention to mobilize Chilean health workers as HIV/AIDS prevention leaders. The intervention was first developed in Botswana, then adapted for school teachers in Malawi, and now is being used to train health workers, community adults, and adolescents in Malawi. Health workers are key to success in the struggle to contain the HIV/AIDS pandemic. Chile has an incipient AIDS epidemic, but the epidemic is now spreading to the general population, beyond traditional high-risk groups. Very few efforts are now directed at containing the epidemic or preparing health workers for a role in HIV prevention. This model of peer group leader training for health worker mobilization is low cost and sustainable, and highly relevant for Chile and the Latin American region. The Chile research will be a partial replication of the Malawi study. In Phase I, a formative evaluation using focus groups and interviews with health administrators and workers will allow us to tailor the intervention and evaluation instruments for health workers in Chile. A quasi-experiment with pretest and post-test observations of health workers and clients in five intervention clinics and five comparable control clinics will evaluate the effects of the intervention. Process evaluation will document quality of the intervention. Health worker-client observations and interviews with health workers pre and post intervention in five intervention and five delayed-intervention control clinics will allow us to test hypotheses about changes in health services and health workers at three months post-intervention. Health services outcomes include: consistent practice of universal precautions, showing sensitivity toward HIV-related concerns, and incorporation of HIV prevention messages. Health worker outcomes include: increased HIV/AIDS knowledge, more positive attitudes toward persons living with HIV/AIDS and toward HIV prevention, and increased HIV prevention behaviors at work and in their personal lives. Power analysis indicates that the sample of 457 workers per clinic, with an 80% participation rate, will be adequate to test small to medium expected effects at a power of 0.80. Results will be disseminated to health workers and policy makers. Full participation by four Chilean coinvestigators and workshops by the US team will build research capacity at the host institution. The intervention is a low-cost sustainable model for national mobilization of health workers for HIV prevention.