Know Your Network: A concurrency reduction intervention

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DESCRIPTION (provided by applicant): This proposal seeks support for formative research to refine an HIV prevention intervention that focuses on concurrent partnerships. Concurrency happens when a person begins a sexual relationship with a new partner before ending a relationship with a previous partner. Over a decade of research has shown that this behavior increases the epidemic potential in a population. Evidence also increasingly suggests that concurrency plays a key role in explaining the generalized epidemics of HIV in the sub-Saharan African region, and there is growing consensus that a trial of a concurrency reduction intervention is needed. We have a preliminary design for a randomized trial of a community-level concurrency intervention based on the concept of "Know Your Network" (KYN). It evolved from study dissemination activities in Western Kenya and is designed to be integrated into the rollout of home based counseling and testing (HCT) that is beginning throughout sub-Saharan Africa. The intervention has a two component, village-level activity that we seek to evaluate here: (1) a set of interactive exercises aimed at increasing awareness of concurrency and fostering an intuitive understanding of how concurrency increases the community level risk of HIV spread; (2) a brief 9 question survey that engages the participants in providing anonymous behavioral data on the timing and sequence of sexual partnerships, which is collected using handheld devices, centrally downloaded and transformed on site into simulations of their sexual partnership network, and discussed collectively. If this intervention can be shown to be feasible, acceptable and qualitatively effective, we have identified a site where it can be integrated into three successive waves of HCT, making it possible to identify changes in HIV incidence associated with the combined interventions. The current proposal seeks support for the formative research needed at this stage. The specific aims are to: (1) Refine the design of the village-level activities that will be used as part of the KYN intervention, using traditional East African participatory meetings (mabaraza) with village chiefs and elders, community representatives and health care workers, and focus group discussions with community members; (2) Pretest the KYN intervention with one full trial run in a single village immediately following a scheduled round of HCT; and (3) Evaluate the intervention using the mabaraza method and modify as needed. If successful, this intervention has great promise because it leverages the principle of "herd immunity" to obtain maximal reductions in transmission with minimal reductions in behavior. PUBLIC HEALTH RELEVANCE: Concurrent sexual partnerships appear to play an important role in explaining the severe generalized epidemics in the sub-Saharan African region. This project develops a concurrency reduction intervention designed to be integrated into the new community oriented programs of home-based counseling and testing. This combination of behavioral and biomedical interventions offers a natural integration of testing, treatment and prevention, and a unique opportunity to conduct a rapid, economical randomized trial of the effectiveness of this approach.