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、实施和测试同龄人小组干预，以动员智利卫生工作者作为艾滋病毒/艾滋病预防领导者。这种干预措施最初是在博茨瓦纳开发的，然后适用于马拉维的学校教师，现在正被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/艾滋病大流行斗争取得成功的关键。智利的艾滋病疫情刚刚开始，但现在这种流行病正在蔓延到普通人群，超出了传统的高危人群。现在几乎没有针对控制疫情或让卫生工作者在艾滋病毒预防中发挥作用的努力。这种针对卫生工作者动员的同龄人组长培训模式成本低、可持续，并与智利和拉丁美洲地区高度相关。智利的研究将部分复制马拉维的研究。在第一阶段，使用焦点小组和对卫生行政人员和工作人员的访谈进行的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。对五家干预诊所和五家可比对照诊所的卫生工作者和客户进行测试前和测试后观察的准实验将评估干预的效果。过程评估将记录干预的质量。五个干预和五个延迟干预对照诊所的卫生工作者-客户观察和干预前后对卫生工作者的访谈将使我们能够检验关于干预后三个月卫生服务和卫生工作者变化的假设。卫生服务成果包括：一致地实行普遍预防措施，对与艾滋病毒有关的问题表现出敏感性，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/艾滋病知识的增加，对艾滋病毒/艾滋病感染者和艾滋病毒预防的更积极的态度，以及在工作和个人生活中更多的艾滋病毒预防行为。功率分析表明，每个诊所457名工作人员的样本，参与率为80%，将足以在功率为0.80的情况下测试中小型预期效果。结果将向卫生工作者和政策制定者传播。四名智利合作研究人员的全面参与和美国团队的研讨会将增强主办机构的研究能力。这一干预措施是一种低成本、可持续的全国动员卫生工作者预防艾滋病毒的模式。

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.