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Feeling Better About HIV
(FBAH)
Abstract
The history of HIV/AIDS counseling in Kenya is short. The ravenous effects of
HIV/AIDS have been traditionally identified with its physical manifestations and
little attention paid to the psychological trauma that generally accompanies the
disease. However, the need to address the forgotten emotional wellbeing of people
living with HIV/AIDS (PHIV) has been gaining traction in many regions throughout
Sub-Saharan Africa. The Kenyan government along with the Kenya AIDS Society
(KAS), a local non-Governmental Organization, has identified HIV/AIDS counseling
as a crucial category of care that should be integrated as part of its healthcare
delivery to PHIV (Burnard 112). The recognition of the importance of the mental
health of PHIV has occurred in recent years for several reasons. First, the heavy
costs associated with the physical treatment of HIV/AIDS, such as the purchasing of
antiviral drugs and HIV testing, have resulted in increased acceptance of alternative
non-physical and less costly methods of care. Psychological counseling services are
not dependent on drugs or medicines and thus can be offered at a lower cost
(Vollmera 1557). In addition to the cost saving benefits of HIV/AIDS counseling,
addressing the mental health of PHIV provides tangible medical and social benefits.
Improved mental health of PHIV helps them to maximize their quality of life and
modify their risk behaviors so as to minimize the risk of HIV transmission. (Green 7)
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Problem Outline
Despite the benefits of improving the mental health of people living with
HIV/AIDS (PHIV), psychological counseling has been non-existent category of care
in the treatment of HIV/AIDS in Kenya. The inability to capitalize on the medical and
social benefits of mental health care is attributable to definable structural problems
in the Kenyan health care delivery system, the primary one of which is its lack of
adequately trained mental health professionals. Consequently, the problem that our
proposal Feeling Better About HIV (FBAH) seeks to address is to correct the shortage
of trained professional counselors or paraprofessional counseling (PPC) in Kenya,
which has significantly constrained the nation’s capacity to address the growing
need for psychological care among PHIV (Vollmera 1558). As an initial first stage of
what we hope will be an eventual countrywide initiative, FBAH will be implemented
in Kenya’s largest city of Nairobi. Although reducing the shortages of PPC may lead
to improved mental health, we understand that it is not a panacea and greater
efforts are still needed to meet the ultimate challenge of eradicating HIV/AIDS.
Objectives
The overall goal of FBAH is to improve the capacity of the Kenyan health care
system to capitalize on mental health treatment opportunities, while meeting future
demand for mental health care services. As the prevalence of HIV/AIDS throughout
Sub-Saharan Africa is likely to continue its upward trajectory, the urgency for
paraprofessional counseling (PPC) to meet the mental health needs of PHIV is a
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challenge that the Kenyan health care system must confront. In addition to the
short-term goal of expanding Nairobi’s mental health care capacity, we also hope to
achieve the long-term impact of changing the attitudes and behaviors of Kenyan
society in general, towards a more acceptable understanding of HIV/AIDS.
Methodology
I. Conceptualization of RBM:
“A picture is worth a thousand words” is a popular saying. The analogy
implies that pictures are useful for conveying complex and abundant information in
a fast and recognizable way. This conceptualization also applies to Results Based
Management (RBM). It is a tool that deconstructs the complexity of the research
project; planning, implementation and evaluation, in a logical and easily identifiable
way. The logical feature is one component of RBM that is highly applicable to the
particular needs of our project and a key reason why it was adopted for use. Its logic
framework, which considers inputs, activities, outputs and outcomes, will allow us
to disseminate highly technical and unfamiliar psychological concepts and themes
that are central components of our paraprofessional counselor training (PPC). The
cause and effect logic of the results chain framework will also assist in organizing
and analyzing our project objectives, concerns, strategies and desired impacts in a
manner easily discernible to all stakeholders, from PHIV, potential PPC trainees,
local government agencies and donors (amongst others).
A second key component of RBM is its emphasis on stakeholder participation.
It promotes the integration of all participants as key figures throughout the lifecycle
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of our project, and enriches the project design through the inclusion of multiple
perspectives (Cox 6). The participatory framework of RBM is conducive to the
collaborative design of FBAH. Our program implementation and planning will rely
heavily on the input and participation of local community stakeholders. Success will
be dependent on local commitment and solidarity with our project initiatives and
objectives. HIV/AIDS is a highly taboo subject throughout Kenya and one which is
rarely discussed. Thus, the establishment of our counseling program which
addressing this sensitive topic will require the trust and acceptance of local
participants. This can only be achieved with a participatory approach that engages
community stakeholders as valued participants and rightful owners of FBAH.
We realize that RBM is not perfect and will not account for all the difficulties
that FBAH will encounter. Its collaborative framework, though a key strength, also
makes it vulnerable to indecision when timely decision making is necessitated. As a
result, increased vigilance will be paid to ensure that consensus among our
stakeholders is achieved in a timely and efficient manner, without compromising the
integrity and overall objectives of FBAH.
II. Data Collection:
Our data collection will rely on a combination of qualitative and quantitative
data and on a range of research methods. This will be done is to ensure that our key
stakeholder concerns are reflected in all phases of our project. However, before our
implementation phase can begin, reliable information must be collected from which
a critical assessment of our project assumptions, concerns, risks and projections can
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be rationalized.
Data will be collected from two distinct units of analysis who are also
primary stakeholders. The first unit of analysis will be our paraprofessional
counselor (PPC) recruits who will be trained to provide the majority of the mental
health care services to PHIV. Focus groups with pre-qualified PPC’s will be
conducted to assess the extent of training required to administer our mental health
care service, and to obtain PPC input on our training objectives and techniques.
The second unit of analysis is people living with HIV/AIDS (PHIV). This unit
comprises our primary target audience for mental health care treatment. Research
on PHIV will be gathered through interview survey questionnaires. The information
collected will be used for monitoring and evaluation of our project outcomes and
impacts, and therefore must be reliable and statistically sound. To maximize the
statistical validity of our research data, both qualitative and quantitative data will be
collected from PHIV. This will allow us to conduct both inductive and deductive
evaluations of our collected data, and to ensure that a thorough situation analysis of
our program design is performed.
Unlike the qualitative nature of focus group data interview survey
questionnaires offer a greater degree of empirical validity (Babbie 255). Our use of
probability sampling and random selection in the data gathering and analysis
process will increase the reliability and accuracy of our research data. The initial
PHIV survey analysis will be conducted in the early assessment phase of FBAH. This
will provide a solid base of information from which the monitoring of our project
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activities, outputs and outcomes can be compared against subsequent follow-up
surveys, to be conducted in the ensuing phases of FBAH. Ongoing survey analysis of
PHIV of will be used as a key indicator for assessing the effectiveness and overall
progress of FBAH. Additionally, analysis of PHIV survey data, utilizing the RBM logic
chain, will help our research team identify key cause and effect relationships
between mental health treatment (activity), outputs and outcomes.
Lastly, a cohort study of PHIV will be conducted to measure changes in their
attitudes and behavior over the lifespan of FBAH. The data collected from this study
in combination with interview survey data will allow us to accurately monitor
FBAH‘s progress. The flexibility of RBM to adapt to changing conditions on the
ground requires accurate and reliable information as a starting point. As a result,
the data collection phase of our project will be extensive and exhaustive to ensure
that the information with which our assumptions and ultimate decisions are based
is accurate and realistic.
III. Data Analysis:
Quantitative and qualitative analysis will be conducted on data obtained from our
cohort study, focus groups, and interview surveys. Collected data will be coded and
operationalized using grounded theory methodology. The manifest content of our
qualitative and quantitative data will be observed, compared, and analyzed to
uncover any general patterns that may emerge. Following the observation process,
coding will be applied to key concepts and themes identified from the observed
patterns. CAQDAS coding software program (Babbie 234) will then be applied to our
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coded data to operationalize our raw data into a statistically verifiable format. To
maintain objectivity during the data observation and coding processes, and to avoid
what Babbie calls “the art of social science research” (Babbie 89), our researches
will utilized the critical reflexivity technique of self-reflection and contemplation, to
guard against researcher bias. Ultimately, accurate and reliable data analysis
depends on equally accurate and reliable data collection. With this in mind, our
research design has incorporated various methods of both data collection and
analysis, which should provide an accurate cross section of the issues and problems
that FBAH will encounter.
IV. Performance Framework:
Results Based Management (RBM) Performance Framework
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Table 1
Purpose :-
To increase the numbers of trained
paraprofessional counselors in Nairobi in
order to meet the demand for mental health
care of people living with HIV/AIDS (PHIV).
Budget:- $ 550,000
Project Name:-
Feel Better About HIV (FBAH)
initiative.
Timeframe:-
24 months
HOW? WHAT WE WANT? WHY?
Inputs Activities Outputs Outcomes Impact
Professionally
trained
psychologists
Design a focus
group for
paraprofessional
recruits
Conduct a focus
group and gather
collect data Paraprofessional
counselors have
acquired with
new counselling
skills
Improved mental
wellbeing of PHIV
due greater
access to mental
health treatment
Improved
attitudes and
perception of
PHIV towards
HIV/AIDS
Increased
capacity of
Nairobi’s mental
health care
treatment
Change in the
attitudes and
perception of
Kenyan
society
towards
HIV/AIDS
Prevalence
rate of HIV
declines in
Kenya
Paraprofession
al recruits
Administer
interview surveys
to PHIV
Research team
Interpreters
Create an
interview survey
to be
administered to
people living with
HIV (PHIV)
Office
Equipment,
supplies, travel
and hotel
Design a cohort
study for people
living with HIV
(PHIV)
Implement a cohort
study with PHIV
Offices
Designing a
curriculum,
courses, and
training materials
A tested and
relevant up to date
curriculum and
introduction
package introduced
PHIV
participants
Design a training
program for
paraprofessional
psychological
counselors
Conduct training
program for
paraprofessionals
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Feeling Better About HIV
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INDICATORS
Monitor changes in PHIV attitudes
and behaviour and HIV prevalence
rates in Nairobi
Outputs Outcomes Impact
Analyse interview
survey and cohort
study results
Positive
chance in
PHIV risk
behavior
Reduction in HIV
prevalence
Stakeholders
Donors Paraprofessional
counsellors
PHIV
Research
Team
Local communities
Assumptions and Risks
The primary assumption of our project is the causal relationship between psychological
counseling and improvement in mental wellbeing.
Table 2
V. Risk Assessment:
In RBM, the approach is to accept the presence of risk and plan accordingly by
attempting to bring the internal and external factors under management control
(Corea 455). Our research design pays critical attention to external risk factors. A
major external risk that we have identified is the possibility of an invalid cause and
effect relationship between mental health counselling and improved PHIV mental
wellbeing. Though the assumption of validity was derived from previous mental
health and HIV/AIDS research conducted in other regions of Sub-Saharan Africa,
from researcher experience and knowledge, and corroborated by the Kenyan
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government along with the Kenya AIDS Society (KAS), its probability within a
particular Kenyan context, specifically Nairobi, is nevertheless still unknown. The
probability that after extensive data collection and analysis no causal relationship
between mental health counselling and improved PHIV wellbeing can be found is a
possible outcome that cannot be discounted or controlled.
However, moderate risk factors such as a lack of trust of FBAH within the
local community, or the breach of confidentiality of our PHIV participants, are less
formidable risk factors that can be mitigated. Consensus building among FBAH and
local stakeholders is one way of establishing good stakeholder relationships and
building trust among the local communities. A high degree of local ‘buy-in’ into our
program’s goals and vision can provide a high degree of protection any unforeseen
obstacles or risks that may emerge.
VI. Monitoring:
Our primary assumption of causality, between mental health counseling and
improved mental wellbeing of PHIV, will be monitored and evaluated during the
early assessment phase of FBAH. Analysis of our research data will allow us to
determine the concreteness of our primary cause and effect assumption. Given our
expected confirmation of the validity of this assumption, monitoring of our mental
health counseling and mental wellbeing variables will be ongoing throughout the
various phases of FBAH. Monitoring the interaction between these two variables
will allow us to better understand their causal links. The outcomes of their
interaction, such as possible changes in the attitudes and behaviors of PHIV, will also
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serve as a key indicator of the overall progression and effectiveness of FBAH.
. Other key indicators to be monitored are the attitudes and opinions of PPC
regarding the efficiency and effectiveness of our mental health care design and
implementation, as well as changes in the prevalence rate of new HIV/AIDS
infections in Nairobi. Though the later variable is a less reliable indicator of FBAH’s
effectiveness, due to its highly dependent nature, it can nonetheless serve as a
general trend indicator to gauge the movement of HIV/AIDS infection in Nairobi. A
vast increase or decrease in the infection rate of HIV/AIDS during FBAH lifespan
may indicate that mental health and HIV prevalence are not correlated. However,
incremental decrease of HIV infections in Nairobi during the implementation of
FBAH may be a promising indication that our mental health treatment program is
causally linked to HIV prevalence. However, a long-term study that reaches beyond
the scope of FBAH will be necessary before any conclusive correlation between
mental health of PHIV and reduced HIV prevalence can be speculated. Nevertheless,
the monitoring process is an important tool for measuring the cause and effect
relationships between project activities, inputs and outcomes, and for validating key
project assumptions
Ethical Considerations
The major ethical consideration of FBAH is centered on the issue of confidentiality
and privacy of PHIV participants. The topic of HIV/AIDS in Kenya is highly
contentious, due to the extreme social stigma associated with the disease. Anyone
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(FBAH)
suspected of having HIV/AIDS are socially isolated and even abandoned by family
members. As a result, PHIV are unwilling to divulge their HIV status or even seek out
treatment for the disease. Therefore, it is essential that our commitment to
upholding the confidentiality of all PHIV participants in our program is well
established. Our research team understands the serious consequences to the lives of
PHIV if their HIV status is divulged. We also understand the risks that the fear of HIV
stigmatization may have on the integrity of the data collected from PHIV. However,
through local participatory action we hope to gain the trust of local communities so
that the lives of our participants and the integrity of our research are not
compromised.
Results Dissemination
Evaluating progress will be an ongoing process throughout the life of our program.
Researchers will be responsible for submitting weekly progress and self-reflexivity
reports to gauge the overall effectiveness of our project and to ensure that
stakeholders remain engaged and involved with stakeholder. The ongoing cohort
and interview survey analyses will be regular indictors of any changes in our PHIV
target group. These changes will provide a good barometer as to the general
direction of our project, whether our desired objectives and outcomes are being
attained. A final situation analysis at the end of our project life cycle will also be
completed to show the longitudinal progression of FBAH, from the planning and
assessment phase, to the final evaluation and recommendation phase.
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Proposed Budget
Personnel Expenses
NO of
Staff Salary
Total
Monthly Yearly
Salary 5
5,00
0
25,00
0
300,00
0
Transportation Allowance 5 500 2,50 30,00
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0 0
Field Allowance
Air tickets Expenses
Medical Expenses 5 500
2,50
0
15,00
0
Total 345,000
Table 3
Table 4
Proposed Budget
Description Costs ($) Costs ($)
Year 1 Year 2
Personnel Expenses 345,000 345,000
Location/Space 50,000 50,000
Electricity And Water Expenses 12,000 12,000
Telephone Service and Calls 12,000 12,000
Post And Telegram Expenses 5,000 5,000
Travelling And Air tickets Exp 30,000 30,000
Translator 25,000 25,000
Textbooks and Handouts 10,000 -
Entertainment & Refreshments Exp. 5,000 5,000
Stationary Expenses 5000 5000
Contingency Expenses (10%) 50,000 50,000
TOTAL Budget 549,000 539,000
Key Stake Holders
Table 5
KEY STAKEHOLDERS Description
Donors Private contributor who has a keen
interest in HIV and mental health.
Kenyan Government
Local NGO
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Paraprofessional Counsellors Local recruits who receive psychological
counselling training to treat the mental
health of PHIV.
PHIV People living with HIV/AIDS who comprise the
main focus of our project
Researcher Team The researchers will be responsible for
the project throughout timeframe and
they will also be accountable for any risk
and assumptions that came about
Time Table
Table 6
Work Stream Planned Activity Timeframe
Data Collection This will consist of both qualitative and
quantitative data. Data collection will
be conducted using the following
methods:
A) Interview survey questionnaire of
people living with HIV (PHIV).
6 Months
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B) Ongoing cohort study of PHIV
C) Focus group study of
paraprofessional counsellors to get
their input regarding the design and
implementation of our mental health
treatment program.
Data Analysis Grounded theory methodology will be
used analyse our gathered data.
Through observation of our data
general patterns will be identified and
coded in order that our raw data can
be operationalized
2 Months
Hiring The
Qualified staff
After our data has been analysed and
the implementation phase of our
program is ready to begin
administrative staff will be hired to
facilitate the completion of the
remaining phases of FBAH.
2 Months
Setting up the
recruitment
centre
The next step will consist of our team
in Kenya setting up the recruitment
centre with school supplies and
textbooks and pamphlets needed
1 Month
Training the
Counsellors
This process will focus on recruiting
and training of our paraprofessional
counselors
5 Months
Implementatio
n
After the completion of our planning
and assessment phase of the project,
including recruitment and training of
counsellors, the implementation phase
of FBAH will commence.
2 Months
Evaluation Will be completed throughout the entirety
of the project. However, a final evaluation
of the overall performance of the project
will be completed in the final phase of
FBAH.
3 Months
Evaluation
The immediate goal of our project was to improve the capacity of Nairobi’s
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mental health delivery system while attempting to affect changes in the behaviors
and attitudes of PHIV. A direct outcome of our immediate goal we hope will be to
significantly improve the mental wellbeing of PHIV. The evaluation of this outcome
is measured using two different research methods. First, a cohort study targeting
PHIV will allow us to detect any behavioral or emotional changes that may result
from increased mental health care treatment.
Secondly, the interview survey that will be ongoing over the lifespan of our
project is another evaluation tool that will allows us to also measure changes in
behaviors and attitudes. However, a simpler and timelier method of evaluation is to
analyze the enrollment rate of PHIV into our program. Increasing enrollment and
participation may indicate that FBAH is having a positive impact.
Long-term objectives of FHAB, such as changes in societal towards HIV/AIDS
cannot be measured since their outcomes extends beyond the timeframe of FHAB.
Thus, the evaluation process can provide a cross-sectional view of short-term cause
and effect relationships but loses its effectiveness when variables are beyond the
reach of researchers.
Works Cited
Babbie, Earl and Lucia Benaquisto. Fundamentals Of Social Research. Toronto:
Nelson. 2002. Print.
Burnard, P. Perception of Aids Counselling. Chicago: Rutledge. 2003. Print
Corea, Ernest. “Dynamics of HIV on Behavioral Changes.” Behind The Headlines. 36.1
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(2004): 344-357. Print.
Green, John. “Counselling for HIV infections and AIDS: the past and the future.” AIDS
Care. (1989). 1:5–10. Print.
Peltzer K, Hira et al. “Psychosocial counselling of patients infected with human
immunodeficiency virus (HIV) in Lusaka, Zambia.” Tropical Doctor (1989)
19:164-168. Print.
Vollmera Nancy A. and Joseph J. Valadeza. “A psychological epidemiology of people
Seeking HIV/AIDS counselling in Kenya: an approach for improving counsellor
training.” Aids. (1999). 13: 1557-1567. Print.
Williams G. “From fear to hope. AIDS care and prevention at Chikankata Hospital,
Zambia.” Strategies for Hope. Oxford: AMRE. (1990)1.3: Print.
Table of Content
Abstract 1.
Problem Outline 2.
Objective 3
Methodology 3
I. RBM conceptualization 3
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II. Data collection 4
III. Data Analysis 6
IV. Performance Framework 8
V. Risk Assessment 9
VI. Monitoring 10
Ethical Considerations 12
Results Dimension 12
Proposed Budget 14
Key Stakeholders 15
Time Table 16
Evaluation 17
Works Cited 18
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