HIV, Sexually Transmitted Infections (STI)
Conditions
Keywords
pilot, HIV prevention, behavior change, risk communication, HIV self-testing, social networks
Brief summary
The Community Popular Opinion Leader (CPOL) is an intervention dveloped in the United States which identifies, trains, and enlists key opinion leaders within communities to deliver messages to peers and help link them to services. This project involves testing the feasibility and acceptability of such a localized version of the CPOL intervention in rural South Africa. This will be achieved through a pilot intervention in three purposively selected communities in the Hlabisa sub-district of uMkhanyakude district, KwaZulu-Natal. The investigators will select potential peer leaders in three ways (at random; based on nominations by peers; based on statistical analysis of previously collected social network data). Peer leaders will be invited to attend four weekly training sessions to learn about HIV prevention and persuasive communication. They will then be coached to start HIV prevention conversations with peers, including provision of HIV self-test kits and linkage to healthcare services. The investigators will evaluate this pilot using group discussions, in-depth interviews and brief pre/post questionnaires with session facilitators, peer leaders, contacted peers and healthcare providers. The investigators will analyse the data collected with the Practical, Robust Implementation and Sustainability Model (PRISM) dissemination and implementation framework, identifying factors likely to affect Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM).
Detailed description
The CPOL intervention is a local adaptation of an intervention package developed with Black men-who-have-sex-with-men (MSM) in the United States. This pilot trial studies both the overall effectiveness of this adapated intervention in rural South Africa, and the differential benefit of selecting participants using three different methods: 1) at random; 2) based on peer nominations of local opinion leaders; 3) based on a community-wide social network built from nominations of important social contacts. While the primary outcome is quantitative, the study is not powered to see statistically significant differences between arms. The evaluation focus of the pilot trial is the process evaluation, which will follow the RE-AIM framework to assess how and why the intervention worked, failed or needed adjustment. The end result will be a CPOL-style intervention package that may (or may not) be appropriate for rural South Africa, and a methodology for adapting CPOL packages for other sexual health contexts. The process evaluation will include qualitative group and in-depth one-to-one interviews with: (i) session trainers; (ii) POL trainees; (iii) peers in the local community; (iii) HIV service providers. It will also include a short pre/post questionnaire for all trainees to capture key knowledge and attitude outcomes relating to the training.
Interventions
BEHAVIORALCPOL group training
Trained research assistants will deliver four two-hour training sessions to a group of \~20 young adults, leading to the trainees providing sexual health information and HIV self-tests (with onward self-referral to local clinics) to their friends and close contacts. Sessions include training on local sexual health information, effective communication strategies, practice conversations and feedback.
Sponsors
Africa Health Research Institute
University College, London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Selection from the population to participate in the intervention is conducted using different methods in each study arm, each defined by a geographic location. Methods are applied to locations at random.
Eligibility
Sex/Gender
ALL
Age
18 Years to 28 Years
Healthy volunteers
Yes
Inclusion criteria
* Resident in Sixhumene study area household
Exclusion criteria
* Unable to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of HIV self-tests distributed | From enrollment to 4 weeks after last training session | The mean number of HIV self-tests distributed to peers by trainees |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of peer conversations held | Enrollemnt to 4 weeks after last training session | Mean number of conversations trainees report holding with peers |
| Trainee HIV ART knowledge improvement | Enrollment to end of last session (4 week period) | Mean change in scores pre/post intervention on a 5-item ART knowledge question set \[range 0-5; higher = better\] |
| Trainee HIV PrEP knowledge improvement | Enrollment to end of last session (4 week period) | Mean change in scores pre/post intervention on a 5-item PrEP knowledge question set \[range 0-5; higher = better\] |
| Trainee generalized self-efficacy improvement | Enrollment to end of last session (4 week period) | Mean change in scores pre/post intervention on the Generalized Self Efficacy-short form (GSE 6) scale \[range 6-24; higher = better\] |
| Trainee ART/PrEP self-efficacy improvement | Enrollment to end of last session (4 week period) | Mean change in scores pre/post intervention on a 4-item self-efficacy-short form scale specific to ART and PrEP use \[range 4-16; higher = better\] |
| Trainee ART/PrEP stigma reduction | Enrollment to end of last session (4 week period) | Mean change in scores pre/post intervention on a 6-item ART/PrEP use stigma question set \[range 6-24; higher = worse\] |
Countries
South Africa
Contacts
CONTACTGuy Harling, ScD
Outcome results
None listed