05 Slabbert Sahara Conference M Slabbert 2

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05 Slabbert Sahara Conference M Slabbert 2

  1. 1. HIV- HIV+ CD4<350 VL<50 CD4>250
  2. 2. Prevention… Primary prevention: prevention of diseases and conditions before biological onset Secondary prevention: the identification and interdiction of diseases that are present in the body, but that have not progressed to the point of causing signs, symptoms, and dysfunction Tertiary prevention: the prevention of disease progression and suffering after it is clinically obvious. It prevents morbidity and mortality Retention through Motivation Definition adapted from: Robert B Wallace, The Gale Group Inc
  3. 3. VCT+ … VCT(+): Confidential HIV screening, CD4 staging, TB questionnaire, referral VCT+ is not an outcome VCT+ entry point into a continuum of care 100% uptake of target group Annual VCT+ Prevalence & incidence
  4. 4. Retention Strategies Applied in the Community Intensive adherence management Childcare program Sports program Drama and music Theatre “The Miracle” Entrepreneurship Retention through motivation
  5. 5. CHAMP Prevention program •Community participation •Family involvement •Integrated into Social Mobilisation •Integrated into Primary Healthcare
  6. 6. Outcome measures of success… Primary prevention: reduced Prevalence & Incidence (VCT+, CD4, stigma) Secondary prevention: earlier care seeking behaviour (VCT+, CD4, stigma) Tertiary prevention: lowered morbidity & mortality Retention for life – motivation & destigmatisation
  7. 7. Some early results…
  8. 8. Mean Baselines 400 300 mean of cd4count 200 100 0 0 1 Mean baseline cd4 count at clinic (0=NMC, mean baseline cd4 count=189.5 cells/ul) and Outreach patients (1= Outreach patients, mean baseline cd4 counts= 341.7cells/ul)
  9. 9. What has gone wrong with past strategies • Atheoretical not informed by behavioural science models • Target groups not assessed, messages not tailored to target population, • Messaging too broad with a general focus • Information without practical advice • Fail to motivate, do not teach behavioural skills • Not rigorously evaluated • Not disseminated widely Fisher, JD SA AIDS conference 2009. Changing AIDS- Risk behaviour
  10. 10. mean of age 0 10 20 30 40 0 Mean Ages 1
  11. 11. Sex distribution 0 1 Female 1 Male 2 Graphs by time
  12. 12. Thank you Questions & Discussion

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