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Smalls BL, Eddens K, Kruse-Diehr A, Williams E, Ortz CL. Assessing the availability of trusted health information in a rural Appalachia community using social network analysis. Heliyon 2023; 9:e13774. [PMID: 36873488 PMCID: PMC9981922 DOI: 10.1016/j.heliyon.2023.e13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The purpose of this study was to investigate how trusted health information is transmitted within a rural Appalachian community. Egocentric social network methods were used to identify and characterize influential community members ("alters") that participants ("egos") go to for trusted health advice. Friends and "other health professionals" were named most frequently as health advice alters, and health advice was described as frequent and helpful. Participants could count on their health advice network for multiple forms of social support. Understanding trusted sources of health advice will allow us to identify community members to serve as change agents for rural T2DM interventions.
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Affiliation(s)
- Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, USA
- Corresponding author.
| | - Katherine Eddens
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, USA
| | - Aaron Kruse-Diehr
- Department of Health, Behavior, and Society, University of Kentucky College of Public Health, USA
| | - Edith Williams
- Department of Public Health Sciences, Medical University of South Carolina, USA
| | - Courtney L. Ortz
- Department of Family and Community Medicine, University of Kentucky College of Medicine, USA
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Okeke SR. "It was protected, except, it wasn't [with] a condom": a mixed-methods study of BBVs/STIs protective practices among International University Students in Sydney, Australia. BMC Public Health 2022; 22:2168. [PMID: 36434571 PMCID: PMC9700902 DOI: 10.1186/s12889-022-14512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A number of previous sex-related studies among international students in Australia and other Western societies may be limited by conflating students from conservative and non-conservative sexual backgrounds. Such conflation leads to situations where nuances and complexities around sex-related experiences are lost or, at most, tangentially investigated. To address this research problem, this study used a mixed-methods design to examine protective practices against blood-borne viruses and sexually transmissible infections (BBVs/STIs) among Sydney-based East Asian and sub-Saharan African international students. METHODS This mixed-methods study generated quantitative data using anonymous online survey (n = 149), and qualitative data through in-depth interviews (n = 20). The main recruitment strategy involved advertising the study through paper and electronic flyers. Quantitative data were analysed using logistic regression, while interviews data were analysed using reflexive thematic analysis. RESULTS Self-reported BBVs/STIs protective practices in the last 12 months include abstinence (28.7%), consistent condom use (19.9%), occasional condom use (18.7%), single partner fidelity (25.1%), other strategies (1.8%), and nothing (5.8%). Further, findings from the bivariate analysis showed higher BBVs/STIs prevention knowledge, lower acculturation into Australian sexual culture, greater access to sexual health information, less conservative sexual norms, greater emotional social support and older age were significantly associated with increased protective practices. Variables significant at bivariate level were entered into a logistic regression. The model was statistically significant, (X2(6) = 31.33, p < 0.01) and explained 33.1% of the variance in BBVs/STIs protective practices. However, only acculturation to sexual norms in Australia (OR = 0.883, 95% CI = 0.820-0.952) was found to be independent predictor of BBVs/STIs protective practices. The results of the study based on the quantitative data, indicated condom use (consistent and occasional) was the most reported BBVs/STIs protective behaviour among sexually active participants. Therefore, interviews data was used to explore condom-use motives and practices. The interviews results showed participants primary concern as regards condom use was around pregnancy and not BBVs/STIs. Thus, some participants described safe sex largely as contraception, with BBVs/STIs constituting a secondary concern or no concern at all. CONCLUSIONS Based on the results of this study, tailored sexual health interventions for international students; which incorporate strategies for modifying perceived sexual norms in Australia, are advocated. In addition, this study recommends sexual health interventions that promote dual protection of condoms for both contraception and BBVs/STIs.
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Affiliation(s)
- Sylvester Reuben Okeke
- grid.1005.40000 0004 4902 0432Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Nxumalo V, Nxumalo S, Smit T, Khoza T, Mdaba F, Khumalo T, Cislaghi B, McGrath N, Seeley J, Shahmanesh M, Harling G. Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study. Wellcome Open Res 2022; 7:164. [PMID: 36324699 PMCID: PMC9608251 DOI: 10.12688/wellcomeopenres.17896.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.
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Affiliation(s)
- Vuyiswa Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Fikile Mdaba
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thulile Khumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Faculty of Social Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, 4041, South Africa
- MRC/Wits-Agincourt Unit, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Harvard Univeristy, Cambridge, MA, 02138, USA
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Ryan JH, Young A, Musara P, Reddy K, Macagna N, Guma V, Seyama L, Piper J, van der Straten A. Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe. AIDS Behav 2022; 26:996-1005. [PMID: 34907478 PMCID: PMC8840901 DOI: 10.1007/s10461-021-03454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/03/2022]
Abstract
Women who acquire HIV during the pregnancy and breastfeeding periods have a higher risk of transmitting the virus to their child than women who become infected with HIV before pregnancy. We explore the context of sexual beliefs and practices that may shape both HIV risk and willingness to use HIV prevention products during pregnancy and postpartum in Malawi, South Africa, Uganda and Zimbabwe. Twenty-three single sex focus group discussions and 36 in-depth interviews took place between May and November 2018 with recently pregnant or breastfeeding women, men, mothers and mothers-in-law of pregnant or breastfeeding women, and key informants. Participants across study groups and sites (N = 232) reported various perceived benefits and harms of sex during pregnancy and postpartum. Participants discussed reasons why men might seek sex outside of the relationship. There is a critical need for alternative prevention options to protect pregnant and breastfeeding women from HIV.
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Affiliation(s)
- Julia H. Ryan
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
| | - Alinda Young
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
| | - Petina Musara
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | | | - Victor Guma
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Linly Seyama
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Ariane van der Straten
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA USA
| | - the MTN-
041/MAMMA Study Team
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
- FHI 360, Durham, NC USA
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
- DAIDS, NIH/NIAID, Bethesda, MD USA
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA USA
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Adeagbo OA, Seeley J, Gumede D, Xulu S, Dlamini N, Luthuli M, Dreyer J, Herbst C, Cowan F, Chimbindi N, Hatzold K, Okesola N, Johnson C, Harling G, Subedar H, Sherr L, McGrath N, Corbett L, Shahmanesh M. Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis. BMJ Open 2022; 12:e048780. [PMID: 35165105 PMCID: PMC8845207 DOI: 10.1136/bmjopen-2021-048780] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal. METHODS Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach. RESULTS Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake. CONCLUSION Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
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Affiliation(s)
- Oluwafemi Atanda Adeagbo
- Department of Health Promotion, Education & Behaviour, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
- Department of Sociology, University of Johannesburg, Auckland Park, South Africa
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Janet Seeley
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Dumsani Gumede
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Sibongiseni Xulu
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Nondumiso Dlamini
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Manono Luthuli
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Jaco Dreyer
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Carina Herbst
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - F Cowan
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- CeSHHAR Zimbabwe, Harare, Zimbabwe
| | - Natsayi Chimbindi
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | | | - Nonhlanhla Okesola
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Guy Harling
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lorraine Sherr
- University College London Faculty of Population Health Sciences, London, UK
| | - Nuala McGrath
- Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Liz Corbett
- Infectious and Tropical Diseases, LSHTM, London, UK
| | - Maryam Shahmanesh
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
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Ndabula Y, Macleod C, Young LS. Sistering and sexual socialisation: a discursive study of Xhosa women's sisterly interactions concerning sex and reproduction. Cult Health Sex 2021; 23:1406-1420. [PMID: 32895028 DOI: 10.1080/13691058.2020.1785551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Considerable research has been devoted to understanding and promoting parent-child sexual socialisation. Less attention has been paid to experiences of sibling interactions concerning sex. Drawing on discursive psychology, this study explores how women report interacting about sex and reproduction in their sisterly relationships. Ten in-depth interviews were conducted, using Free Association Narrative Interview technique, with five Black isiXhosa-speaking, middle-aged and working class women in South Africa. Findings show that the participants construct their sisterly interactions concerning sex drawing on three interpretative repertoires: silence; safety and secrecy; risk and responsibilisation. The silence repertoire constructs sex talk between sisters as vague and non-viable. Within the safety and secrecy repertoire, sisters are constructed as sharing sexual secrets and providing a safe space for sexual exploration. The risk and responsibilisation repertoire is deployed when understandings of 'proper' feminine behaviour and sexual purity are breached, with sisters emphasising the importance of avoiding risk and acting responsibly. Thus, alongside encouraging the expression of women's agency in relation to sexuality, sisters potentially join a patriarchal policing and the shaming of women's sexuality. These contradictory repertoires have implications for sexual health programmes and interventions targeted at family communication about sex.
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Affiliation(s)
- Yanela Ndabula
- aCritical Studies in Sexualities and Reproduction, Rhodes University, Grahamstown, South Africa
| | - Catriona Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Grahamstown, South Africa
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Shahmanesh M, Okesola N, Chimbindi N, Zuma T, Mdluli S, Mthiyane N, Adeagbo O, Dreyer J, Herbst C, McGrath N, Harling G, Sherr L, Seeley J. Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa. BMC Public Health 2021; 21:1393. [PMID: 34256725 PMCID: PMC8278686 DOI: 10.1186/s12889-021-11399-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa - especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN). METHODS Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18-30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016-2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial ( NCT04532307 ). RESULTS Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me'). The intervention included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just "onward referral". In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components: structured assessment tool to tailor health promotion and referrals, safe spaces and community advocacy to create an enabling environment, and peer-mentorship and navigation of resources to improve retention in HIV prevention. CONCLUSION Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.
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Affiliation(s)
- Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK.
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | | | - Natsayi Chimbindi
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
| | - Thembelihle Zuma
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sakhile Mdluli
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Oluwafemi Adeagbo
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- University of Southampton, Southampton, UK
| | - Guy Harling
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
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8
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Shahmanesh M, Mthiyane TN, Herbsst C, Neuman M, Adeagbo O, Mee P, Chimbindi N, Smit T, Okesola N, Harling G, McGrath N, Sherr L, Seeley J, Subedar H, Johnson C, Hatzold K, Terris-Prestholt F, Cowan FM, Corbett EL. Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery. BMJ Glob Health 2021; 6:e004574. [PMID: 34315730 PMCID: PMC8317107 DOI: 10.1136/bmjgh-2020-004574] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVE We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators). METHODS We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care (SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18-30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18-30 year olds within their social networks. Seeds received 20 Rand (US$1.5) for each recipient who distributed further packs. The primary outcome was PrEP/ART linkage, defined as screening for PrEP/ART eligibility within 90 days of pack distribution per peer navigator month (pnm) of outreach, in women aged 18-24 (a priority for HIV prevention). Investigators and statisticians were blinded to allocation. Analysis was intention to treat. Total and unit costs were collected prospectively. RESULTS Between March and December 2019, 4163 packs (1098 SOC, 1480 PND, 1585 IPN) were distributed across 24 clusters. During 144 pnm, 272 18-30 year olds linked to PrEP/ART (1.9/pnm). Linkage rates for 18-24-year-old women were lower for IPN (n=26, 0.54/pnm) than PND (n=45, 0.80/pnm; SOC n=49, 0.85/pnm). Rate ratios were 0.68 (95% CI 0.28 to 1.66) for IPN versus PND, 0.64 (95% CI 0.26 to 1.62) for IPN versus SOC and 0.95 (95% CI 0.38 to 2.36) for PND versus SOC. In 18-30 year olds, PND had significantly more linkages than IPN (2.11 vs 0.88/pnm, RR 0.42, 95% CI 0.18 to 0.98). Cost per pack distributed was cheapest for IPN (US$36) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN. DISCUSSION HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators. TRIAL REGISTRATION NUMBER NCT03751826.
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Affiliation(s)
- Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Carina Herbsst
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Melissa Neuman
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Oluwafemi Adeagbo
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Paul Mee
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, London, UK
| | - Natsayi Chimbindi
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Faculty of medicine, University of Southampton, Southampton, Hampshire, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Department of Global Health &Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Hasina Subedar
- South African National Department of Health, Pretoria, South Africa
| | - Cheryl Johnson
- HIV, Hepatitis and STI Department, World Health Organisation, Geneva, Switzerland
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, USA
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Frances M Cowan
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Elizabeth Lucy Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- TB-HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Abstract
BACKGROUND Despite the development of several efficacious HIV prevention and treatment methods in the past 2 decades, HIV continues to spread globally. Uptake of interventions is nonrandomly distributed across populations. Such inequality is socially patterned and reinforced by homophily arising from both social selection (becoming friends with similar people) and influence (becoming similar to friends). METHODS We conducted a narrative review to describe how social network analysis methods-including egocentric, sociocentric, and respondent-driven sampling designs-provide tools to measure key populations, to understand how epidemics spread, and to evaluate intervention take-up. RESULTS Social network analysis-informed designs can improve intervention effectiveness by reaching otherwise inaccessible populations. They can also improve intervention efficiency by maximizing spillovers, through social ties, to at-risk but susceptible individuals. Social network analysis-informed designs thus have the potential to be both more effective and less unequal in their effects, compared with social network analysis-naïve approaches. Although social network analysis-informed designs are often resource-intensive, we believe they provide unique insights that can help reach those most in need of HIV prevention and treatment interventions. CONCLUSION Increased collection of social network data during both research and implementation work would provide important information to improve the roll-out of existing studies in the present and to inform the design of more data-efficient, social network analysis-informed interventions in the future. Doing so will improve the reach of interventions, especially to key populations, and to maximize intervention impact once delivered.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C. Tsai
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston MA United States
- Mbarara University of Science and Technology, Mbarara, Uganda
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