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Ferguson L, Gruskin S, Bolshakova M, Rozelle M, Yagyu S, Kasoka K, Oraro-Lawrence T, Motala A, Stackpool-Moore L, Hempel S. Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination. AIDS 2023; 37:1919-1939. [PMID: 37352492 PMCID: PMC10552822 DOI: 10.1097/qad.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Ceylan E, Koç A. Effect of peer education model on nursing students' knowledge and attitudes towards HIV/AIDS. NURSE EDUCATION TODAY 2021; 99:104808. [PMID: 33610052 DOI: 10.1016/j.nedt.2021.104808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/22/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This research is an intervention study designed as a single group pre-test post-test model without control group in order to examine the effect of education provided to nursing students based on peer education model on HIV/AIDS knowledge level and attitude. DESIGN, METHODS, SETTINGS AND PARTICIPANTS The research was carried out at Nursing Department of Ankara Yıldırım Beyazıt University. Sample of the study consisted of second year nursing students who agreed to participate in the study and enrolled Internal Medicine Nursing course for the first time (n = 88). In the first stage of the study, nine peer mentors were selected and a total of 12 h of training were given to them by the researchers. In the second stage, peer mentors provided a total of 12 h of training to nine peer students groups. All groups were created by simple randomization on the "research randomizer" website. Demographics questionnaire, AIDS knowledge scale and AIDS attitude scale were used to collect the data. Data was analyzed by using descriptive statistics, Pearson Chi-square test, paired sample t-Test, Wilcoxon test and Spearman correlation test. RESULTS It was determined that peer education provided a statistically significant increase in AIDS knowledge scale score in peer students (pretest x¯=10.32 ± 3.59, posttest x¯=19.69 ± 1.51) (p < 0.001). In addition, peer education was found to provide a statistically significant increase in AIDS attitude scale score in peer students (pretest x¯=56.64 ± 8.36, posttest x¯=72.95 ± 7.02) (p < 0.001). CONCLUSION It has been determined that peer education method is an effective method in increasing HIV/AIDS knowledge and attitude towards people living with HIV/AIDS in nursing students. Therefore, it is recommended to include peer education model in nursing educations regarding HIV/AIDS.
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Affiliation(s)
- Erdal Ceylan
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey.
| | - Ayşegül Koç
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
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Lyons CE, Olawore O, Turpin G, Coly K, Ketende S, Liestman B, Ba I, Drame FM, Ndour C, Turpin N, Ndiaye SM, Mboup S, Toure-Kane C, Leye-Diouf N, Castor D, Diouf D, Baral SD. Intersectional stigmas and HIV-related outcomes among a cohort of key populations enrolled in stigma mitigation interventions in Senegal. AIDS 2020; 34 Suppl 1:S63-S71. [PMID: 32881795 DOI: 10.1097/qad.0000000000002641] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The current study aims to assess longitudinal differences in stigma and HIV outcomes among key populations at risk for and living with HIV. DESIGN Key populations enrolled into two parallel prospective cohorts; one for female sex workers and one for sexual and gender minorities (SGMs). Participants were recruited from three urban areas in Senegal; were followed for 24 months; and had the option to participate in an integrated stigma mitigation intervention. METHODS Participants included individuals both at risk for and living with HIV. Sociobehavioral questionnaires and biological HIV testing were administered every 3-4 months. Longitudinal analyses used nonparametric Chi-squared test for trends and multivariable logistic regression with generalized estimating equations. RESULTS 183 SGM and 192 sex workers were enrolled. Among SGM participants, 39.9% were living with HIV at baseline and incidence over 24 months was 3.21/100 person-years. Among sex workers, 36.6% were living with HIV at baseline and incidence was 1.32/100 person-years. Among SGM, perceived healthcare stigma (P < 0.001), anticipated healthcare stigma (P < 0.001), and perceived friend stigma (P = 0.047) reduced, but differed by HIV status for perceived [adjusted odds ratio (aOR): 3.51; 95% confidence interval (CI): 1.75, 7.06] and anticipated healthcare stigmas (aOR: 2.85; 95% CI: 1.06-7.67). Among sex workers perceived healthcare stigma (P = 0.043) and perceived friend stigma (P = 0.006) reduced. Viral suppression increased among SGM (P = 0.028) and was associated with perceived (aOR: 2.87; 95% CI: 1.39-5.55) and enacted healthcare stigma (aOR: 0.42; 95% CI: 0.18-0.99). CONCLUSION Overall, there were decreases in stigmas observed but clear differences in stigma patterns by HIV status. These data highlight the need to consider specific strategies to address multiple intersecting stigmas as a means of improving HIV-related prevention and treatment outcomes among key populations with diverse identities.
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Smith MK, Xu RH, Hunt SL, Wei C, Tucker JD, Tang W, Luo D, Xue H, Wang C, Yang L, Yang B, Li L, Joyner BL, Sylvia SY. Combating HIV stigma in low- and middle-income healthcare settings: a scoping review. J Int AIDS Soc 2020; 23:e25553. [PMID: 32844580 PMCID: PMC7448195 DOI: 10.1002/jia2.25553] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. METHODS We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. RESULTS AND DISCUSSION Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. CONCLUSIONS Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.
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Affiliation(s)
- M. Kumi Smith
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Richie H. Xu
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Shanda L. Hunt
- Health Sciences LibrariesUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Chongyi Wei
- Department of Health Behavior, Society and PolicyRutgers UniversityNew BrunswickNYUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Hao Xue
- Freeman Spogli Institute for International StudiesStanford UniversityStanfordCAUSA
| | - Cheng Wang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Ligang Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Bin Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Li Li
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
| | - Benny L. Joyner
- Division of Pediatric Critical Care MedicineSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Sean Y. Sylvia
- Department of Health Policy & ManagementUniversity of North CarolinaChapel HillNCUSA
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Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence. PLoS One 2019; 14:e0211298. [PMID: 30682131 PMCID: PMC6347272 DOI: 10.1371/journal.pone.0211298] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal of ending the epidemic of HIV by 2030 set by the United Nations Joint Program of HIV/AIDS (UNAIDS) will thus only be achieved if HIV-related stigma and discrimination are reduced. The objective of this review was to locate, appraise and describe international literature reporting on interventions that addressed HIV-related SAD in healthcare settings. Methods The databases searched were: Cumulative Index to Nursing and Allied Health (CINAHL), Excerpta Medica Database from Elsevier (EMBASE), PubMed and Psychological Information (PsycINFO) database. Two individuals independently appraised the quality of the papers using appraisal instruments from the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI. Quality of evidence for major outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results We retained 14 records reporting on eight studies. Five categories of SAD reduction (information-based, skills building, structural, contact-based and biomedical interventions) were identified. Training popular opinion leaders (POLs) resulted in significantly lower mean avoidance intent scores (MD = -1.87 [95% CI -2.05 to -1.69]), mean prejudicial attitude scores (MD = -3.77 [95% CI -5.4 to -2.09]) and significantly higher scores in mean compliance to universal precaution (MD = 1.65 [95% CI 1.41 to 1.89]) when compared to usual care (moderate quality evidence). The Summary of Findings table (SOF) is shown in Table 1. Conclusions Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal precaution. Very low quality evidence indicates that professionally-assisted peer group interventions, modular interactive training, participatory self-guided assessment and intervention, contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma.Further Randomized Controlled Trials (RCTs) are needed. Future trials need to use up-to-date and validated instruments to measure stigma and discrimination.
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Affiliation(s)
- Garumma Tolu Feyissa
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
- * E-mail:
| | - Craig Lockwood
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
| | - Zachary Munn
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
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Wiginton JM, King EJ, Fuller AO. 'We can act different from what we used to': Findings from experiences of religious leader participants in an HIV-prevention intervention in Zambia. Glob Public Health 2018; 14:636-648. [PMID: 30238830 DOI: 10.1080/17441692.2018.1524921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Faith-based organisations (FBOs) have long been part of the fight against HIV and AIDS. International bodies continue to collaborate with FBOs to implement HIV-prevention programmes with mixed success. Zambia has been a target of such programmes in part due to its high HIV prevalence. The Trusted Messenger approach to provide religious leader networks with biomedical, science-focused education about HIV and AIDS was piloted in 2006, but participant experiences of the intervention have not been explored qualitatively. In 2016, in-depth interviews were conducted of 34 randomly chosen individuals who attended Trusted Messenger workshops between 2006 and 2016 in Livingstone, Lusaka, and the Copperbelt region. Findings indicate that the religious leader attendees gained scientific insights about HIV which motivated their action in personal, social, and religious contexts. Participants found the science comprehensible and empowering and identified workshop frequency and language as challenging. Utilising science-focused education within contextual settings of religious leader networks can combat the spread of HIV and the mistreatment of people living with HIV and AIDS.
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Affiliation(s)
- John Mark Wiginton
- a Department of Health Behaviour & Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Elizabeth J King
- a Department of Health Behaviour & Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - A Oveta Fuller
- b Department of Microbiology & Immunology , School of Medicine, University of Michigan , Ann Arbor , MI , USA
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Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh. J Adolesc Health 2017; 60:S35-S44. [PMID: 28109339 DOI: 10.1016/j.jadohealth.2016.09.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated. METHODS A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15-24 years was implemented before and after the second stigma training to assess client satisfaction with services. RESULTS Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%-19.7%-16.3%; p < .001), as did agreement that sexually active young people (50.3%-36.0%-21.7%; p < .001) and men who have sex with men (49.3%-38.0%-24.0%; p < .001) engage in "immoral behavior." Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%-97.6%; p < .001). CONCLUSIONS This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed.
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Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health 2016; 16:741. [PMID: 27503191 PMCID: PMC4977618 DOI: 10.1186/s12889-016-3462-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/05/2016] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Methods In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization. Results A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support. Conclusions Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals’ decision to seek out and remain in appropriate care.
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Ferrer L, Bernales M, Cianelli R, Cabieses B, Triviño X, Reed R, Irarrázabal L, Peragallo N, Norr K. Mano a Mano for health professions students in Chile: a pilot HIV prevention program. J Assoc Nurses AIDS Care 2015; 26:680-8. [PMID: 26122140 PMCID: PMC4859151 DOI: 10.1016/j.jana.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Lilian Ferrer
- Director of International Affairs, School of Nursing, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Margarita Bernales
- Assistant Professor, School of Nursing, Universidad del Desarrollo, Santiago, Chile
| | - Rosina Cianelli
- Professor, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Báltica Cabieses
- Assistant Professor, School of Nursing, Universidad del Desarrollo, Santiago, Chile
| | - Ximena Triviño
- Associate Professor, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Reiley Reed
- Research Assistant, School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lisette Irarrázabal
- Assistant Professor, School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nilda Peragallo
- Dean and Professor, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Kathleen Norr
- Professor, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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Lourenço C, Kandula D, Haidula L, Ward A, Cohen JM. Strengthening malaria diagnosis and appropriate treatment in Namibia: a test of case management training interventions in Kavango Region. Malar J 2014; 13:508. [PMID: 25518838 PMCID: PMC4301656 DOI: 10.1186/1475-2875-13-508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/14/2014] [Indexed: 12/01/2022] Open
Abstract
Background Despite its importance in control and elimination settings, malaria diagnosis rates tend to be low in many African countries. An operational research pilot was conducted in Namibia to identify the key barriers to appropriate diagnosis of malaria in public health facilities and to evaluate the effectiveness of various training approaches in improving the uptake and adherence to rapid diagnostic tests (RDTs). Methods After identifying case management weaknesses through focus group discussions, training interventions were designed to address these barriers over a six-month period. The study had three intervention districts and one control within the Kavango region of Namibia where poor case management practices were observed. The interventions included an enhanced training model, clinical mentorship, and SMS reminders. Monthly data on testing and treatment were collected for the period of April to September 2012 and, for comparison, the same months during the prior year from all 52 health facilities in Kavango. The same indicators were also obtained at district level for a follow-up period of 15 months from October 2012 to December 2013 to observe whether any improvements were sustained over time. Results All intervention arms produced significant improvements in case management practices compared to the control district (all p < 0.02). Overall, districts receiving any training improved testing rates from 25% to 66% at minimum compared to the control. The enhanced training plus mentorship arm resulted in a significantly greater proportion of fevers receiving RDTs compared to the district receiving enhanced training alone, increasing from 27% to over 90% at endline. No ACT was prescribed to untested patients after caregivers received mentorship or SMS reminders. These improvements were all sustained over the 15-month follow-up. Conclusions These changes show a reversal of improper case management practices over the six-month study period and demonstrate that implementing simple training interventions can have a significant, sustainable impact on the uptake of and adherence to malaria RDTs. Findings from this work have already informed Namibia’s roll out of a more robust case management training programme. The approaches used in Namibia may be applicable to other resource-constrained countries, providing practical guidance on sustainable approaches to febrile illness management. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-508) contains supplementary material, which is available to authorized users.
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Burke HM, Fleming PJ, Guest G. Assessment of the psychometric properties of HIV knowledge items across five countries. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:577-87. [PMID: 25490737 PMCID: PMC6626987 DOI: 10.1521/aeap.2014.26.6.577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
HIV knowledge is commonly measured in HIV prevention research and program evaluations, but rigorous measurement standards are not always applied. Using item response theory methods, we examined the psychometric functioning of five commonly used HIV knowledge questions in five countries with varying HIV prevalence. We evaluated the internal consistency and measurement invariance of the items. The items performed poorly in all samples and the scale as a whole did not perform equally across samples. We conclude that current ways of measuring HIV knowledge are not adequate and recommend new items be developed, tested, and validated using psychometric methods.
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Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc 2013; 16:18734. [PMID: 24242268 PMCID: PMC3833106 DOI: 10.7448/ias.16.3.18734] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. METHODS We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. RESULTS Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. CONCLUSIONS Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, International Center for Research on Women, Washington, DC, USA;
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Birch AP, Tuck J, Malata A, Gagnon AJ. Assessing global partnerships in graduate nursing. NURSE EDUCATION TODAY 2013; 33:1288-1294. [PMID: 23664107 DOI: 10.1016/j.nedt.2013.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 03/21/2013] [Accepted: 03/26/2013] [Indexed: 06/02/2023]
Abstract
North-South partnerships in graduate nursing education can prepare students to address global healthcare issues, increase cultural competence, and build research capacity. However, the current literature does not include a critical and systematic assessment of partnerships using established guidelines. This paper has two objectives: 1) Find and refine a suitable measure to assess a North-South inter-institutional research and clinical partnership in nursing; 2) Pilot test an assessment measure and describe the results of a systematic institutional self-evaluation of a developing North-South research and clinical partnership within a graduate nursing program. The first objective was addressed by searching for, examining and selecting an assessment measure. The second objective was obtained by applying the assessment measure to a developing graduate-level research and clinical partnership between a Canadian School of Nursing and a Malawian College of Nursing; qualitative data collected included information from a document review and subjective experiences of partners. Results showed that when appropriate revisions are made to an existing guideline, it is applicable to use as an assessment measure for North-South inter-institutional research and clinical partnerships. Recommendations for improvement were made, allowing the guideline to be more specific for research and clinical partnerships. Results demonstrated that the existing Canadian-Malawian partnership was strongest in the guideline category of "shaping the purpose and scope of the partnership," and weakest in "partnership implementation and context." This paper implies that: 1) evaluation can strengthen partnerships and enhance educational experience for nursing students; 2) research comparing and contrasting different genres of partnerships could help determine which type is the most appropriate for an institutions' particular outcome goals; and 3) effective establishment and maintenance of North-South partnership occurs through an on-going process of evaluation.
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Affiliation(s)
- Amelia P Birch
- McGill University, Ingram School of Nursing, Montreal, QC, Canada.
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Cianelli R, Lara L, Villegas N, Bernales M, Ferrer L, Kaelber L, Peragallo N. Impact of Mano a Mano-Mujer, an HIV prevention intervention, on depressive symptoms among Chilean women. J Psychiatr Ment Health Nurs 2013; 20:263-72. [PMID: 22452388 PMCID: PMC3401514 DOI: 10.1111/j.1365-2850.2012.01907.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Worldwide, and in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low-income Chilean women. Depressed people are less willing to participate in behaviours that protect them against HIV. The aim of this study is to analyze the impact of Mano a Mano-Mujer (MM-M), and HIV prevention intervention, on depressive symptoms among Chilean women. A quasi-experimental design was used for this study. The research was conducted in Santiago, Chile; a total of 400 women participated in the study (intervention group, n=182; control group, n=218). The intervention was guided by the social-cognitive model and the primary health care model. The intervention consists of six 2-h sessions delivered in small groups. Sessions covered: HIV prevention, depression, partner's communication, and substance abuse. Face-to-face interviews were conducted at baseline and at 3-month follow-up. Chilean women who participated in MM-M significantly decreased, at 3 months follow up, their reported depressive symptoms. MM-M provided significant benefits for women's depression symptoms. In this study nurses participated as leaders for the screening of depressive symptoms and as facilitators of community interventions.
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Affiliation(s)
- Rosina Cianelli
- Corresponding author at: University of Miami, School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, Florida 33146, USA. Tel.: +1 305 284 2147.
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Liem A, Adiyanti MG. “Bidan cantik”: Psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center. HIV & AIDS REVIEW 2013. [DOI: 10.1016/j.hivar.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cianelli R, Ferrer L, Norr KF, Miner S, Irarrazabal L, Bernales M, Peragallo N, Levy J, Norr JL, McElmurry B. Mano a Mano-Mujer: an effective HIV prevention intervention for Chilean women. Health Care Women Int 2012; 33:321-41. [PMID: 22420675 DOI: 10.1080/07399332.2012.655388] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.
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Affiliation(s)
- Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
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Chimwaza AF, Chimango JL, Kaponda CPN, Norr KF, Norr JL, Jere DL, Kachingwe SI. Changes in clients' care ratings after HIV prevention training of hospital workers in Malawi. Int J Qual Health Care 2012; 24:152-60. [PMID: 22215760 DOI: 10.1093/intqhc/mzr080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the changes in clients' health-care ratings before and after hospital workers received an HIV prevention intervention in Malawi, which increased the workers' personal and work-related HIV prevention knowledge, attitudes and preventive behaviors. DESIGN Pre- and post-intervention client surveys. SETTING A large urban referral hospital in Malawi. PARTICIPANTS Clients at purposefully selected inpatient and outpatient units on designated days (baseline, n = 310 clients; final, n = 683). INTERVENTION Ten-session peer-group intervention for health workers focused on HIV transmission, personal and work-related prevention, treating clients and families respectfully and incorporating HIV-related teaching. MAIN OUTCOME MEASURES Brief face-to-face clients' interview obtaining ratings of confidentiality of HIV, whether HIV-related teaching occurred and ratings of service quality. RESULTS Compared with baseline, at the final survey, clients reported higher confidence about confidentiality of clients' HIV status (83 vs. 75%, P < 0.01) and more clients reported that a health worker talked to them about HIV and AIDS (37 versus 28%, P < 0.01). More clients rated overall health services as 'very good' (five-item mean rating, 68 versus 59%, P < 0.01) and this was true for both inpatients and outpatients examined separately. However, there was no improvement in ratings of the courtesy of laboratory or pharmacy workers or of the adequacy of treatment instructions in the pharmacy. CONCLUSIONS HIV prevention training for health workers can have positive effects on clients' ratings of services, including HIV-related confidentiality and teaching, and should be scaled-up throughout Malawi and in other similar countries. Hospitals need to improve laboratory and pharmacy services.
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Norr KF, Ferrer L, Cianelli R, Crittenden KS, Irarrázabal L, Cabieses B, Araya A, Bernales M. Peer group intervention for HIV prevention among health workers in Chile. J Assoc Nurses AIDS Care 2012; 23:73-86. [PMID: 21497113 PMCID: PMC3140569 DOI: 10.1016/j.jana.2011.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 02/10/2011] [Indexed: 11/26/2022]
Abstract
We tested the impacts of a professionally assisted peer-group intervention on Chilean health workers' HIV-related knowledge, attitudes, and behaviors using a quasi-experimental design with a pretest and 3-month posttest. Two Santiago suburbs were randomly assigned to the intervention or delayed intervention control condition. Five community clinics per suburb participated. Interested workers at the intervention (n = 262) and control (n = 293) clinics participated and completed both evaluations. At posttest, intervention clinic workers had higher knowledge and more positive attitudes regarding HIV, condoms, stigmatization, and self-efficacy for prevention. They reported more partner discussion about safer sex, less unprotected sex, and more involvement in HIV prevention activities in the clinic and the community, but they did not report fewer sexual partners or more standard precautions behaviors. Because of these positive impacts, the program will become a regular continuing education unit that can be used to meet health-worker licensing requirements.
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Anderman EM, Cupp PK, Lane DR, Zimmerman R, Gray DL, O'Connell A. Classroom Goal Structures and HIV/Pregnancy Prevention Education in Rural High School Health Classrooms. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2011; 21:904-922. [PMID: 24876759 PMCID: PMC4034542 DOI: 10.1111/j.1532-7795.2011.00751.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Over 5,000 adolescents enrolled in required rural high school health courses reported their perceptions of mastery and extrinsic goal structures in their health classrooms. Data were collected from all students at three time points (prior to HIV/pregnancy instruction, three months after instruction, and one year after instruction). Results indicated that classroom goal structures were related to both proximal and distal knowledge, attitudes, intentions, and efficacy beliefs. Results in particular indicate that the perception of a mastery goal structure in health education classrooms fosters knowledge, improved attitudes, enhanced efficacy beliefs, and lower intentions to have sexual intercourse.
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Valdés BC, Lagunas LF, Villarroel LA, Acosta RC, Miner S, Silva MB. HIV/AIDS knowledge and occupational risk in primary care health workers from Chile. INVESTIGACION Y EDUCACION EN ENFERMERIA 2011; 29:212-221. [PMID: 25284913 PMCID: PMC4183353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the relationship between knowledge level and occupational risk exposure to HIV/AIDS in primary care health workers. METHODOLOGY Analytical cross-sectional study. 720 health workers from Santiago answered a survey about HIV/AIDS that included: knowledge level (appropriate, inappropriate), occupational risk (with or without risk), and control variables (age, gender, health center, education and marital status). Descriptive and association analysis were performed. Odds Ratio (OR) was estimated through simple and multiple regressions logistics. RESULTS 58.7% of the participants reported HIV occupational risk. 63.8% of the participants from the exposed group reported an appropriate level of knowledge, versus 36.1% of the non-exposed group (Adjusted OR of 3.1, IC95%OR: 2.0-4.8, p<0.0001). Technicians and cleaning staff reported a lower proportion of appropriate level of knowledge compared to the employees with college education (p<0.0001). CONCLUSION The level of HIV/AID occupational risk is directly associated with the level of knowledge of the disease.
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Affiliation(s)
- Baltica Cabieses Valdés
- Enfermera-Matrona, Magíster en Epidemiología, Doctoranda en Ciencias de la Salud, profesora de la Escuela de Enfermería de la Universidad del Desarrollo-Clínica Alemana, Chile.
| | - Lilian Ferrer Lagunas
- Enfermera-Matrona, Doctor of Philosophy. Directora de Investigación de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, Chile.
| | - Luis Antonio Villarroel
- Bioestadístico, Doctor en Estadística. Profesor de la Escuela de Medicina de la Pontificia Universidad Católica de Chile, Chile.
| | - Rosina Cianelli Acosta
- Enfermera matrona, Doctora en Enfermería. Profesora de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, Chile.
| | - Sarah Miner
- Enfermera, Magíster en Enfermería. Profesora de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, Chile.
| | - Margarita Bernales Silva
- Psicóloga, Magíster en Psicología de la Salud. Profesora de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, Chile.
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Kaponda CPN, Norr KF, Crittenden KS, Norr JL, McCreary LL, Kachingwe SI, Mbeba MM, Jere DLN, Dancy BL. Outcomes of an HIV prevention peer group intervention for rural adults in Malawi. HEALTH EDUCATION & BEHAVIOR 2011; 38:159-70. [PMID: 21393624 DOI: 10.1177/1090198110378588] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.
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Mbeba MM, Kaponda CPN, Jere DL, Kachingwe SI, Crittenden KS, McCreary LL, Norr JL, Norr KF. Peer group intervention reduces personal HIV risk for Malawian health workers. J Nurs Scholarsh 2011; 43:72-81. [PMID: 21342427 PMCID: PMC3073810 DOI: 10.1111/j.1547-5069.2011.01384.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi. DESIGN Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection. METHODS The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences. FINDINGS Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors. CONCLUSION The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention. CLINICAL RELEVANCE Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.
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Affiliation(s)
- Mary M Mbeba
- Nursing, Midwifery and Health Sciences Research Centre, Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
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McCreary LL, Kaponda CPN, Kafulafula UK, Ngalande RC, Kumbani LC, Jere DLN, Norr JL, Norr KF. Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box. HEALTH EDUCATION RESEARCH 2010; 25:965-78. [PMID: 20837655 PMCID: PMC2974837 DOI: 10.1093/her/cyq049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 08/13/2010] [Indexed: 05/29/2023]
Abstract
This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention.
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Chimango JL, Kaponda CN, Jere DL, Chimwaza A, Crittenden KS, Kachingwe SI, Norr KF, Norr JL. Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi. J Assoc Nurses AIDS Care 2009; 20:293-307. [PMID: 19576546 PMCID: PMC2763430 DOI: 10.1016/j.jana.2009.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/16/2009] [Indexed: 11/30/2022]
Abstract
Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.
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Affiliation(s)
- Jane L Chimango
- Nursing, Midwifery and Health Sciences Research Centre, Kamuzu College of Nursing, University of Malawi, Lilongwe
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