Mobilizing Health Workers/Community HIV Prevention/Chile

描述（由申请人提供）：拟议的AIDS- firca研究将调整、实施和测试同伴小组干预，以动员智利卫生工作者作为艾滋病毒/艾滋病预防的领导者。该干预措施最初是在博茨瓦纳制定的，然后适用于马拉维的学校教师，现在正用于培训马拉维的卫生工作者、社区成年人和青少年。卫生工作者是遏制艾滋病毒/艾滋病流行斗争取得成功的关键。智利的艾滋病刚开始流行，但这一流行病现在正在向普通民众蔓延，超出了传统的高危群体。目前针对遏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的努力很少。这种动员卫生工作者的同伴小组领导培训模式成本低且可持续，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，利用焦点小组和对卫生管理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人员量身定制干预和评估工具。对五个干预诊所和五个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。在5个干预诊所和5个延迟干预控制诊所对卫生工作者进行干预前后的观察和访谈，将使我们能够检验有关干预后3个月卫生服务和卫生工作者变化的假设。保健服务的成果包括：一贯采取普遍预防措施，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：增加了艾滋病毒/艾滋病知识，对艾滋病毒/艾滋病感染者和艾滋病毒预防持更积极的态度，以及在工作和个人生活中增加了艾滋病毒预防行为。幂次分析表明，每个诊所457名工作人员的样本，参与率为80%，将足以在0.80的幂次下测试中小型预期效应。结果将分发给卫生工作者和决策者。四名智利共同研究者的全面参与和美国团队的研讨会将在主办机构建立研究能力。这项干预措施是动员全国卫生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.