Implementing HIV Risk Reduction Zambia

描述（由申请人提供）：该合作伙伴项目最初于1999年在赞比亚进行试点，是一项基于证据的行为干预，旨在通过增加性屏障知识、可接受性和性屏障产品的使用，降低赞比亚艾滋病毒血清一致（阳性）和不一致的男性和女性传播艾滋病毒/性病和再感染的风险。在过去的8年里，这项研究的成功发现激发了这项“翻译”提案的设计，利用经验丰富的北达科他州卫生保健和咨询人员、小组领导和共同领导来传播、培训、监督和提供后续支持，以在社区一级采用和实施该计划。本建议采用了从预实施到实施、维护和传播的阶段性技术转移过程。我们建议在卢萨卡的6个CHC中对个人（患者）和机构（CHC）层面的干预进行翻译和评估。个体结果将包括社会心理和生物学终点，包括健康和危险行为，以及目标保健中心中符合条件的个体的参与率。制度结果将包括符合条件的社区中心的参与率，在不同环境中提供干预的保真度和一致性，以及在五年研究期间该计划的制度维持（“制度化”）。该研究计划招募240对HIV阳性和不阳性夫妇，评估干预对6家CHC诊所夫妇高危性行为水平的影响。拟议的研究将测试社区环境中的卫生保健人员是否能够保持项目的保真度，以实现与在UTH现场获得的参与者结果相媲美的结果，以及与标准护理（对照- VCT咨询）诊所相比，合作项目诊所的项目参与者是否会在减减性风险方面表现出改善的结果。它还将确定组织变量，这些变量可能随着时间的推移促进或阻碍该计划的采用、实施和维护。这项研究的结果将在赞比亚社区和国际上传播，并用于宣传和提高赞比亚社区保健诊所的现有护理标准。

DESCRIPTION (provided by applicant): The Partner Project, originally piloted in the Zambian context in 1999, is an evidence- based behavioral intervention designed to reduce risk of HIV/STD transmission and re- infection among Zambian HIV sero-concordant (positive) and discordant men and women by increasing sexual barrier knowledge, acceptability and use of sexual barrier products. The successful findings from this study over the last 8 years have stimulated the design of this "translation" proposal to utilize experienced UTH-based health care and counseling staff group leaders and co-leaders to disseminate, train, supervise and provide follow-up support in the adoption and implementation of this program at the community level. This proposal utilizes a staged technology transfer process from pre- implementation to implementation, maintenance and dissemination. We propose to translate and evaluate the intervention at the individual (patient) and institutional (CHC) levels in six CHCs in Lusaka. Individual outcomes will include psychosocial and biological endpoints, including health and risk behaviors, as well as participation rates among eligible individuals in the target CHCs. Institutional outcomes will include the participation rate of eligible CHCs, the fidelity and consistency of delivery of the intervention across settings, and the institutional maintenance ("institutionalization") of the program over the five-year duration of the study. Recruiting 240 HIV+ seroconcordant and serodiscordant couples, the proposed research program will assess the effect of the intervention on the level of high risk sexual behaviors among couples in six CHC clinics. The proposed study will test whether the fidelity of the program can be maintained by health care staff in community settings to achieve participant outcomes comparable to those obtained at the UTH site, as well as whether program participants in Partner Project clinics will demonstrate improved outcomes in sexual risk reduction, as compared to the standard of care (Control - VCT counseling) clinics. It will also identify the organizational variables which may facilitate or inhibit the adoption, implementation and maintenance of this program over time. Results of the study will be disseminated within the Zambian community and internationally, and used to inform and enhance the existing standard of care in Community Health Clinics in Zambia. PUBLIC HEALTH RELEVANCE The proposed study will test whether health care staff in community settings will achieve participant outcomes comparable to those obtained by hospital clients and staff, as well as whether program participants in Partner Project (Experimental) clinics will demonstrate improved outcomes in comparison with participants in "standard of care" (Control) clinics.