Implementing HIV Risk Reduction Zambia

点击翻译按钮获取中文摘要

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.