2.2.2. Research content
2.2.2.1. Pre-intervention survey and intervention model development
Maybe you are interested!
-
Current status of HIV infection, AFB + tuberculosis and evaluation of preventive intervention effectiveness among drug addicts in Dak Lak province - 1 -
Risk of HIV infection and effectiveness of preventive intervention among drug addicts in Quang Nam - 1 -
HIV-STI infection status, some related factors and effectiveness of preventive intervention among Dao ethnic group in 3 communes of Yen Bai province, 2006-2012 - 18 -
Pre- and Post-Intervention Assessment Index -
Chlamydia Infection Distribution by Age Group Before Intervention
We conducted a cross-sectional survey before the intervention in 2011. The data collected in this survey, combined with available local data, we analyzed the data, described in detail the current status of infection, risk behaviors, and identified factors related to HIV risk behaviors among IDUs. Through the survey, we found that, in addition to the common characteristics commonly found in IDUs, in Quang Nam there is also a relatively common group that we call the "Amateur group". This group is young people, newly addicted, often unemployed, seduced by friends, and seeking strange feelings, and addicted to drugs. Most of them are poor, have little money, and do not have enough to buy drugs. They have to pool their money with friends and take turns injecting. If there are not enough clean needles and syringes, the risk of injecting together is very high. In addition, this group is often strong in sexual relations due to the effects of drug use in the first 2 years. If condoms are not used regularly and correctly during sexual relations, HIV can be transmitted to sexual partners and vice versa. Based on the analysis of the research group, we built a theoretical model including HIV prevention intervention activities: Behavior change communication; free condom distribution; clean needles and syringes; and voluntary HIV counseling and testing. We implemented these activities synchronously, strongly, and continuously for 2 years in the research area. The effectiveness of the intervention model was assessed through changes in risk behaviors and HIV prevalence among IDUs after 2 years of intervention.
Behavior change communication activities: First, we established and strengthened a network of peer educators and collaborators in the localities.
Research method. This network regularly and continuously visits drug addicts' homes and public places to approach IDUs, directly communicating to them about safe injection and safe sex behaviors by "whispering to each other". This activity was implemented regularly and continuously during the 2 years of intervention. In addition, we increased mass communication activities through provincial television channels, district and commune loudspeakers to regularly broadcast reports, news and articles on HIV/AIDS prevention and control. At the same time, we organized propaganda rallies, mobile art tours in communes and wards with the content of preventing HIV/AIDS transmission. Distributed many types of communication materials on safe injection and safe sex. For ethnic minority IDUs (accounting for 9.8%), the education level is low; many of them only attended primary school, and are even illiterate. For these people, we choose communicators who are peers and collaborators of ethnic minorities who are easy to approach and communicate directly, and at the same time increase the distribution of visual leaflets.
Clean needle and syringe supply activities: In Quang Nam, the Clean Needle and syringe Program has not been implemented in the whole province for various reasons from the departments and agencies. After organizing a consensus conference, we proceeded to build and strengthen the network of volunteers and collaborators in communes and wards to immediately implement the clean needle and syringe distribution program for IDUs. This activity was implemented in parallel with direct communication on safe injection. The volunteers are former IDUs who have reformed and participated in the program, with priority given to young people to easily reach the "Amateur group". The volunteers will approach IDUs at home or at public places to provide clean needles and introduce HIV/AIDS prevention services. In addition, clean needle and syringe distribution activities are also carried out at commune health stations, pharmacies, etc. In addition, IDUs can also collect
Collect dirty condoms scattered on sidewalks and street corners to exchange for clean condoms, exchange 2 dirty condoms for 1 clean condom.
Strengthening the supply of condoms: Along with direct communication and distribution of clean condoms, the team of volunteers and collaborators regularly distributes condoms to IDUs who want to have sex. This activity has been strongly and continuously enhanced during the 2 years of intervention in the research localities. In addition, condoms are also provided by the health system, pharmacies, etc.
Voluntary HIV testing and counseling activities: Due to limited financial resources, we only opened one more Voluntary HIV testing and counseling room sponsored by the Life-Gap project in addition to the one that was already operating. Voluntary HIV testing and counseling activities are strongly implemented with both models: the self-referred HIV testing and counseling model (CITC) and the physician-referred HIV testing and counseling model (PITC). On the other hand, in mountainous districts, remote areas, where there are no Voluntary HIV testing and counseling rooms, we organize mobile Voluntary HIV testing and counseling to prevent HIV infection for clients before and after testing.
Although previously, communication measures to change behavior and distribute free condoms have been implemented in Quang Nam, they were small-scale, unsynchronized, and discontinuous. The NKT exchange program has not been implemented due to the lack of consensus from the government and other departments and organizations. In this study, the intervention model through activities was carefully prepared from the planning stage, policy advocacy, creating consensus from socio-political organizations to the strong and synchronous implementation of communication activities to change behavior, distribute condoms, exchange NKTs, counseling and HIV testing in all research localities for 2 years.
continuous intervention. Our model is also somewhat different from some models such as: Traditional model, network approach model, continuous support model, performance payment model, online MSM model.
2.2.2.2. Organization of activities
- Organize talks on HIV prevention interventions with local authorities, departments and people in neighborhoods and villages.
- Establish peer education groups, build a network of collaborators to implement behavior change communication activities, distribute condoms and contraceptives
- Organize broadcasts on district/city and commune radio stations. Print documents, leaflets, and billboards at public places.
- Organize communication to change behavior at public places.
- Build facilities to provide condoms at gathering places, pharmacies, commune/ward health facilities, and TVXNTN rooms.
- Build clean needle exchange facilities at TCMT gathering places, public gathering places, pharmacies, commune/ward health stations.
- Organize fixed and mobile TVXNTN activities in localities to provide HIV infection prevention counseling and voluntary testing for research subjects.
Form a peer group:
In each district/city, establish a peer group:
- Functions and duties:
Participate in communication activities to change behavior on HIV/AIDS prevention and control, distribute communication materials on HIV infection prevention.
Provide information on the risk of HIV/AIDS infection.
Reach out to people in locations and areas with a high number of IDUs to distribute communication materials, distribute condoms, and exchange or distribute clean needles and syringes.
Persuade and encourage IDUs to change their behavior: do not share needles and use condoms during every sexual intercourse.
Counseling, care, support and assistance for people with HIV/AIDS.
- Peer group benefits: Receive salary according to project regime
Enjoy general health services and HIV/AIDS prevention and control support services in particular.
Commune/ward collaborator group:
Each village selects 01 collaborator, usually a village health worker. Collaborators are people with knowledge and experience in HIV prevention education and communication, care and counseling for IDUs and people with HIV/AIDS.
- Duties of commune/ward collaborators:
Be the focal point for implementing intervention activities in the community. Implement activities to care for and support people infected with HIV. Coordinate with the National HIV/AIDS prevention and control program.
2.2.2.3. Results of intervention activities
HIV infection prevention interventions were carried out synchronously for 2 years, from January 2012 to December 2013 with the following main contents:
Training on communication and education skills: 22 classes were organized, 556 trainees were commune health workers, village health workers, peer educators and collaborators. Training on harm reduction intervention program: 14 classes were organized, 415 trainees
are peer educators, collaborators and grassroots health workers. Voluntary testing counseling training: 8 classes, 243 trainees are provincial, district and commune health workers.
Strengthen and establish a network of peer educators and collaborators to participate in behavior change communication activities, provide condoms, and exchange condoms in 5 districts, 72 communes, and 458 villages with 466 participants.
Strengthening communication to change behavior: Organized regularly and continuously in 5 districts, the communicators are mainly peer educators and collaborators. In 2 years, direct communication was provided to 15,568 IDUs.
3,184 people infected with HIV and more than 50,000 other subjects (family members of IDUs, migrants...).
Strengthening mass media: broadcasting 6 reports with 62 broadcasts on provincial radio and television through advertising, health and life and news sections. Writing and publishing 24 articles on reports and news in local and central magazines and newspapers.
Organized 6 mobile propaganda campaigns via propaganda vehicles in 5 research districts with 357 loudspeaker broadcasts during the peak month of mother-to-child transmission and the month of action for HIV/AIDS prevention, with a total of about 45,000 listeners. Distributed communication materials: Distributed 11,255 leaflets and brochures to IDUs in the community through a network of peer educators and collaborators.
Increased condom distribution: Condoms were distributed at gathering places, in the community and at health facilities, with a total of 52,426 condoms distributed free of charge to IDUs in 2012-2013.
Strengthen needle exchange: Peer groups and collaborators go to public places, at home... to distribute free needles and syringes to IDUs. In addition, IDUs can also collect dropped needles and syringes to exchange for
New BKT, every 2 old BKTs exchanged for 1 new BKT. Total BKTs distributed in 2 years is 113,380 BKTs.
Strengthening voluntary counseling and testing: In addition to the 2 permanent voluntary counseling and testing rooms at the Preventive Medicine Center and the Provincial Dermatology Center that are open daily to welcome clients for voluntary HIV counseling and testing; we also organize mobile voluntary counseling and testing points in localities far from the voluntary counseling and testing rooms. The total number of voluntary HIV counseling and testing in 2 years is
7,087 people, including 3,154 people with HIV/AIDS in the research districts.
2.2.3. Data collection techniques
2.2.3.1. Research toolkit
Use a common quantitative interview questionnaire for both pre- and post-intervention surveys (Appendix 2). The content of the interview questionnaire includes 14 parts, 143 questions:
+ Part 1: General characteristics.
+ Part 2: TCMT behavior.
+ Part 3: Behavior of sharing BKT.
+ Part 4: Most recent TCMT behavior.
+ Part 5: Network of people with HIV/AIDS.
+ Part 6: Sexual history: number and partners.
+ Part 7: Sexual history with wife and lover.
+ Part 8: History of sexual relations with female sex workers.
+ Part 9: History of sexual relations with casual partners without paying.
+ Part 10: Sexual history with male partners.
+ Part 11: Using condoms.
+ Part 12: Sexually transmitted diseases.
+ Part 13: Knowledge and understanding of HIV/AIDS and HIV testing history.
+ Part 14: HIV/AIDS prevention program in the province.
2.2.3.2. Selection of investigators and supervisors
Investigators: are officers of the Quang Nam HIV/AIDS Prevention and Control Center, District and City Health Centers. Investigators must meet all standards such as skills, experience in investigating the ability to access and exploit information from IDUs; enthusiasm, responsibility, seriousness and have time to participate in research.
Supervisors: are staff from the National Institute of Hygiene and Epidemiology, Nha Trang Pasteur Institute and graduate students. These supervisors directly participated in training courses for supervisors (organized by the National Institute of Hygiene and Epidemiology) and conducted retraining before each investigation for investigators for 2 days on the following contents:
+ Investigation objectives, sampling methods, interview techniques, content and meaning of each part of the Interview Form and of each question.
+ How to collect information and practice using the questionnaire in real life
land.
Role of the researcher in the topic:
The doctoral student (thesis author) is the person who builds the research proposal.
Research, plan the investigation, build the intervention model, coordinate, organize and implement all project activities, participate in all tasks from the beginning to the completion of the project, write the project results report.
In cross-sectional surveys, the researcher is the supervisor of the research team, plans the community survey, participates in training the survey team, and resolves difficulties and problems that arise when collecting data at the field.