Implementing HIV Risk Reduction Zambia

描述（由申请人提供）：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措施，旨在通过增加性障碍知识、性障碍产品的可接受性和使用，降低赞比亚艾滋病毒血清一致（阳性）和不一致男性和女性中艾滋病毒/性病传播和再感染的风险。这项研究在过去8年中的成功发现，刺激了这一“翻译”建议的设计，利用经验丰富的UTH的保健和咨询工作人员小组领导人和共同领导人传播，培训，监督和提供后续支持，在社区一级通过和实施这一方案。这项建议采用了一个分阶段的技术转让过程，从实施前到实施、维护和传播。我们建议在卢萨卡的六个社区卫生中心对个人（患者）和机构（社区卫生中心）层面的干预措施进行翻译和评估。个体结果将包括心理社会和生物终点，包括健康和风险行为，以及目标CHCs中合格个体的参与率。机构结果将包括合格CHC的参与率，在整个设置中提供干预的保真度和一致性，以及在研究的五年期间该计划的机构维持（“机构化”）。招募了240对HIV+血清一致和血清不一致的夫妇，拟议的研究计划将评估干预措施对6个CHC诊所夫妇中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可以保持该计划的忠诚度，以实现与UTH站点获得的参与者结果相当的参与者结果，以及与标准护理（对照- VCT咨询）诊所相比，合作伙伴项目诊所的计划参与者是否会在降低性风险方面表现出改善的结果。它还将确定随着时间的推移可能促进或抑制该计划的采用、实施和维护的组织变量。研究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卫生诊所的现有护理标准。 公共卫生相关性拟议的研究将测试社区环境中的卫生保健人员是否会实现与医院客户和工作人员获得的参与者结果相当的参与者结果，以及合作伙伴项目（实验）诊所的计划参与者是否会证明与“标准护理”（对照）诊所的参与者相比改善的结果。

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.