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Sundararajan R, Hooda M, Lai Y, Nansera D, Audet C, Downs J, Lee MH, McNairy M, Muyindike W, Mwanga-Amumpaire J. Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial. Trials 2024; 25:430. [PMID: 38956628 PMCID: PMC11218186 DOI: 10.1186/s13063-024-08286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Rural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research. METHODS This cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment. DISCUSSION The Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health. TRIAL REGISTRATION ClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).
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Affiliation(s)
| | - Misha Hooda
- Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Yifan Lai
- Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Denis Nansera
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn Audet
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Jennifer Downs
- Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Myung Hee Lee
- Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
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Wassihun Y, Hunegnaw Z, Anagaw TF, Yigzaw ZA, Bogale EK. HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003199. [PMID: 38701049 PMCID: PMC11068206 DOI: 10.1371/journal.pgph.0003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/06/2024] [Indexed: 05/05/2024]
Abstract
Street dwelling is the use of public space as a place of residence and nourishment for children, adolescents, and young people, revealing a complex and multifactorial situation. Moreover, homelessness facilitates HIV transmission and its progression due to the risky lifestyle of individuals. To the best of our knowledge, there is no study conducted in the study area on HIV preventive practices among street dwellers. The aim of this study was to assess HIV prevention practices and associated factors among street dwellers. A community-based cross-sectional study was conducted in Bahir Dar City from March 12, 2023 to April 30, 2023. By using the simple random sampling technique, 424 street dwellers were recruited. Bivariable and multivariable logistic regression were used for analysis. The magnitude of HIV preventive practice among street dwellers was 35.9%. Being male (AOR = 0.23, 95% CI: 0.10, 0.55), educational status (AOR = 7.53, 95% CI: 2.20, 25.6), practice of sex to earn money (AOR = 0.18, 95% CI: 0.08, 0.44), good knowledge about HIV preventive practice (AOR = 2.83, 95% CI: 1.46, 5.49), perceived susceptibility for HIV (AOR = 0.90, 95% CI: 0.81, 0.99), and perceived benefit of using HIV preventive practice (AOR = 1.09, 95% CI: 1.02, 1.17), were factors associated with HIV preventive practice. The magnitude of HIV preventive practice was low. Being male, the ability to read and write, the practice of sex to earn money, good knowledge about HIV preventive practice, perceived susceptibility to HIV, and the perceived benefit of using HIV preventive practice were significantly associated with HIV preventive practice. Therefore, responsible organizations, both governmental and non-governmental, should design inclusive strategies to improve HIV preventive practice among street dwellers by focusing on regular demand creation activities, awareness creation about HIV preventive practice, and sustainable condom distribution in the city.
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Affiliation(s)
- Yosef Wassihun
- Health Promotion and Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Zemed Hunegnaw
- Health Promotion and Behavioral Sciences Department, Amhara Regional Health Bureau, Bahir Dar City, Amhara Region, Ethiopia
| | - Tadele Fentabel Anagaw
- Health Promotion and Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Zeamanuel Anteneh Yigzaw
- Health Promotion and Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
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Erwin J, Burns L, Devalia U, Witton R, Shawe J, Wheat H, Axford N, Doughty J, Kaddour S, Nelder A, Brocklehurst P, Boswell S, Paisi M. Co-production of health and social science research with vulnerable children and young people: A rapid review. Health Expect 2024; 27:e13991. [PMID: 38403901 PMCID: PMC10895074 DOI: 10.1111/hex.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/23/2024] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The term 'care-experienced' refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, 'co-production' refers to the involvement of CYP in the planning or conduct of research with explicit roles in which they generate ideas, evidence and research outputs. AIM To learn how to meaningfully involve vulnerable CYP in the co-production of health and social science research. OBJECTIVES To identify: Different approaches to facilitating the engagement of vulnerable CYP in co-production of health and social science research; different activities carried out in such approaches, challenges to engaging vulnerable CYP in co-production of health and social science research and ways to overcome them and areas of best practice in relation to research co-production with vulnerable CYP. SEARCH STRATEGY A rapid review of peer-reviewed articles was conducted in six databases (MEDLINE, Embase, SocINDEX, CINAHL, PsycINFO and Web of Science) and grey literature to identify studies that engaged vulnerable CYP in co-approaches to health and social research. MAIN RESULTS Of 1394 documents identified in the search, 40 were included and analysed. A number of different approaches to co-production were used in the studies. The CYP was involved in a range of activities, chiefly the development of data collection tools, data collection and dissemination. Individual challenges for CYP and researchers, practical and institutional factors and ethical considerations impacted the success of co-production. DISCUSSION AND CONCLUSION Co-production of health and social science with vulnerable CYP presents challenges to researchers and CYP calling for all to demonstrate reflexivity and awareness of biases, strengths and limitations. Used appropriately and well, co-production offers benefits to researchers and CYP and can contribute to research that reflects the needs of vulnerable CYP. Adherence to the key principles of inclusion, safeguarding, respect and well-being facilitates this approach. PATIENT AND PUBLIC CONTRIBUTION Members of our patient and public involvement and stakeholder groups contributed to the interpretation of the review findings. This manuscript was written together with a young care leaver, Skye Boswell, who is one of the authors. She contributed to the preparation of the manuscript, reviewing the findings and their interpretation.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospital, London, UK
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Jill Shawe
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Hannah Wheat
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Nick Axford
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Janine Doughty
- School of Dentistry, Royal Liverpool University Dental Hospital, Liverpool, UK
| | | | | | | | | | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Plymouth, UK
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Conroy AA, Tebbetts S, Darbes LA, Hahn JA, Neilands TB, McKenna SA, Mulauzi N, Mkandawire J, Ssewamala FM. Development of an Economic and Relationship-Strengthening Intervention for Alcohol Drinkers Living with HIV in Malawi. AIDS Behav 2023; 27:2255-2270. [PMID: 36520335 PMCID: PMC9753077 DOI: 10.1007/s10461-022-03956-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Heavy alcohol use among people with HIV in sub-Saharan Africa is driven by household economics such as poverty and unemployment and has negative impacts on couple relationships. Multilevel interventions have the potential to reduce alcohol use and improve relationship outcomes by addressing the web of co-occurring economic, social, and dyadic factors. This objective of this study was to develop an economic and relationship-strengthening intervention for couples in Malawi, consisting of matched savings accounts with financial literacy training and a couples counseling component to build relationship skills. Informed by the ADAPT-ITT framework, we collected multiple rounds of focus group data with key stakeholders and couples to gain input on the concept, session content, and procedures, held team meetings with field staff and an international team of researchers to tailor the intervention to couples in Malawi, and refined the intervention manual and components. The results describe a rigorous adaptation process based on the eight steps of ADAPT-ITT, insights gained from formative data and modifications made, and a description of the final intervention to be evaluated in a pilot randomized clinical trial. The economic and relationship-strengthening intervention shows great promise of being feasible, acceptable, and efficacious for couples affected by HIV and heavy alcohol use in Malawi.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | - James Mkandawire
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Embleton L, Shah P, Apondi E, Ayuku D, Braitstein P. "If they had a place to live, they would be taking medication": a qualitative study identifying strategies for engaging street-connected young people in the HIV prevention-care continuum in Kenya. J Int AIDS Soc 2023; 26:e26023. [PMID: 37267115 DOI: 10.1002/jia2.26023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/15/2022] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Street-connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention-care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention-care continuum from healthcare providers, policymakers, community members and SCY in Kenya. METHODS This qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in-depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men. RESULTS Our analysis resulted in four major themes corresponding to stages in the HIV prevention-care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient-centred and responsive to the diversity of their circumstances. The use of pre-exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer-based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer-based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence. CONCLUSIONS This study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti-poverty strategies as cash transfers and provision of food. Peer-based interventions are a clear option but require SCY-specific adaptation to be implemented effectively.
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Affiliation(s)
- Lonnie Embleton
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pooja Shah
- London School of Hygiene & Tropical Medicine, London, UK
| | - Edith Apondi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - David Ayuku
- Department of Mental Health and Behavioural Science, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
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Qualitative Analysis Using Social Maps to Explore Young Women's Experiences With Social Support of their Oral PrEP Use in Kenya and South Africa. J Assoc Nurses AIDS Care 2023; 34:45-57. [PMID: 36170124 DOI: 10.1097/jnc.0000000000000363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT Daily oral pre-exposure prophylaxis (PrEP) adherence is challenging. We explored African adolescent girls and young women's (AGYW) perceptions of the social influencers of their PrEP use and the social influencers' PrEP knowledge and support (six focus group discussions; 33 South African and Kenyan AGYW) in the Prevention Options for Women Evaluation Research demonstration project. Participants completed a social mapping exercise indicating strength and direction of influence of members in their social networks. Mothers and counselors were identified as positive influencers and most influential by >50% of participants, sex partners were labeled negative influencers or both positive and negative, and best friends were mostly positive influencers. HIV- and PrEP-related stigma were the major reasons influencers were identified as negative. Participants wanted their social networks to be better educated about PrEP by someone other than the AGYW themselves (e.g., clinic staff) and to support their PrEP use. To improve PrEP adherence, community- and peer-based PrEP sensitization and delivery interventions should be evaluated.
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Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, Nwanunu EC, Elijah LP, Day S, Rosenberg NE, Ong JJ, Nkengasong S, Tang W, Obiezu‐Umeh C, Nwaozuru U, Merino Y, Gbaja‐Biamila T, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2021; 24:e25666. [PMID: 33569913 PMCID: PMC7876473 DOI: 10.1002/jia2.25666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. METHODS We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement. RESULTS We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. CONCLUSIONS We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.
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Affiliation(s)
- Sarah E Asuquo
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kadija M Tahlil
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kathryn E Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and BehaviorArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
| | - Mesoma A Igbokwe
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Kelechi P Chima
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Ezienyi C Nwanunu
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- Department of BiochemistryMichael Okpara University of AgricultureUmudikeNigeria
| | - Lana P Elijah
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineLagos State UniversityLagosNigeria
| | - Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Nora E Rosenberg
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina Project MalawiLilongweMalawi
| | - Jason J Ong
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Central Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Susan Nkengasong
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Chisom Obiezu‐Umeh
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Yesenia Merino
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - David Oladele
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Oliver Ezechi
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Joseph D Tucker
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Embleton L, Di Ruggiero E, Logie CH, Ayuku D, Braitstein P. Improving livelihoods and gender equitable attitudes of street-connected young people in Eldoret, Kenya: Results from a pilot evidence-based intervention. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:227-240. [PMID: 32633059 DOI: 10.1111/hsc.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
Street-connected young people (SCY) in Eldoret, Kenya, experience substantial gender inequities, economic marginalization and are highly vulnerable to acquiring HIV. This study sought to explain and explore how participation in a pilot-adapted evidence-based intervention, Stepping Stones and Creating Futures, integrated with matched savings, changed SCY's economic resources, livelihoods and gender equitable attitudes. We piloted our adapted intervention using a convergent mixed-methods design measuring outcomes pre- and post-intervention with 80 SCY in four age- and gender-stratified groups of 20 participants per group (young women aged 16-19 years and 20-24 years, young men aged 16-19 years and 20-24 years). The pilot occurred at MTRH-Rafiki Centre for Excellence in Adolescent Health in Eldoret, Kenya, from September 2017 to January 2018. Through street outreach, Peer Facilitators created four age- and gender-stratified sampling lists of SCY whom met the eligibility criteria and whom indicated their interest in participating in the intervention during outreach sessions. Simple random sampling was used to select eligible participants who indicated their interest in participating in the intervention. The adapted intervention, Stepping Stones ya Mshefa na Kujijenga Kimaisha, included 24 sessions that occurred over 14 weeks, focused on sexual and reproductive health, gender norms in society, livelihoods and included a matched-savings programme conditional on attendance. The primary outcome of interest was gender equitable attitudes measured using the Gender Equitable Men scale and secondary outcomes included economic resources and livelihoods. Participants had a significant change in gender equitable attitudes from pre- to post-intervention from 43 (IQR 38-48) to 47 (IQR 42-51) (p < .001). Quantitatively and qualitatively participants reported increases in daily earnings, changes in street involvement, housing and livelihood activities. Overall, this study demonstrated that the adapted programme might be effective at changing gender equitable attitudes and improving livelihood circumstances for SCY in Kenya.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David Ayuku
- Department of Behavioural Science, College of Health Science, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya. Int J Public Health 2020; 65:433-443. [PMID: 32270232 PMCID: PMC7275002 DOI: 10.1007/s00038-020-01349-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/29/2020] [Accepted: 03/11/2020] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices. METHODS Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. RESULTS Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. CONCLUSIONS Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.
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