APHA Tabora, Tanzania


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Presentation provides information about community engagement activities associated with study in Tabora, Tanzania.

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APHA Tabora, Tanzania

  1. 1. Establishing a Dialogue with Stakeholders to Assess Sexual Practices Among Women at Higher Risk for HIV Infection in Tabora, Tanzania Dominick Shattuck, Kavita Dave-Coombe, Wambura Mwita, Stafford Kibona, Godwin Nkya, Calvin Sindato, John Changalucha, Kathleen M. MacQueen
  2. 2. Outline <ul><li>Need for HIV Prevention Sites </li></ul><ul><li>Site Information & Challenges </li></ul><ul><li>Framework & Methods Used to Address Challenges </li></ul><ul><li>Findings: </li></ul><ul><li>Tabora as a Potential HIV Prevention Site </li></ul><ul><li>Barriers for Longitudinal Studies </li></ul><ul><li>Mechanisms for Successful Community Engagement </li></ul><ul><li>Next-Steps for Further HIV Study Preparedness </li></ul>
  3. 3. HIV Prevention Research Sites <ul><li>Increased need for HIV prevention trial sites (AMD, 2008) </li></ul><ul><ul><li>Test new products (when available) </li></ul></ul><ul><ul><li>Identify changes in epidemic </li></ul></ul><ul><li>Sites need to be multi-functional (AVAC) </li></ul><ul><ul><li>Trained staff </li></ul></ul><ul><ul><li>Maintained and expanding infrastructure </li></ul></ul><ul><ul><li>Lack of relationships at multiple levels in the community, government and the media has caused problems in other Microbicide trials </li></ul></ul>- NIMR Staff Training, photos by Kavita Coombe
  4. 4. Tabora, Tanzania <ul><ul><li>Location: Western Tanzania </li></ul></ul><ul><ul><li>Pop. ~ 200,000 </li></ul></ul><ul><ul><li>NIMR* Research Center </li></ul></ul><ul><ul><li>Clinical & Behavioral research experience </li></ul></ul><ul><ul><li>Community links established </li></ul></ul><ul><ul><li>Internet & data management capacity </li></ul></ul>Tabora *(NIMR) – National Institute for Medical Research in Tanzania
  5. 5. Tabora, Tanzania <ul><li>Challenges </li></ul><ul><ul><li>Limited information on ability to recruit a sizeable sample of women at higher risk for HIV infection (multiple sexual partners) </li></ul></ul><ul><ul><li>Stigma associated with participating in an HIV research study </li></ul></ul><ul><ul><li>Low levels of research literacy in the community </li></ul></ul>
  6. 6. Capacity Building Activities in Tabora, Tanzania <ul><li>Solution </li></ul><ul><ul><li>Conduct cross-sectional study </li></ul></ul><ul><ul><ul><li>To ascertain whether a sizable number of women at higher risk for HIV infection can be recruited </li></ul></ul></ul><ul><ul><ul><li>To determine their acceptability of hypothetical HIV prevention studies (longitudinal) </li></ul></ul></ul><ul><ul><ul><li>To identify their HIV risk behaviors among the target population </li></ul></ul></ul><ul><ul><ul><li>To enhance links between NIMR-Tabora and the community </li></ul></ul></ul><ul><ul><ul><li>To provide additional training and experience to staff members </li></ul></ul></ul>
  7. 7. Capacity Building Activities in Tabora, Tanzania Community Mapping Respondent Driven Sampling Stakeholder Interviews In-Depth Interview Behavioral Survey Dissemination of Findings Capacity Building Process Community Engagement
  8. 8. Community Engagement: Stakeholder Interviews <ul><ul><li>Provided opportunity to learn about existing HIV prevention programs and objectives of local organizations </li></ul></ul><ul><ul><li>Discuss planned research study </li></ul></ul><ul><ul><li>Identify barriers perceived by stakeholders </li></ul></ul>- NIMR Staff Training, photo by Kavita Coombe
  9. 9. Community Engagement: Community Mapping <ul><ul><li>Modified PLACE Methodology </li></ul></ul><ul><ul><ul><li>500 community informants identified 205 unique venues where individuals meet new sex partners </li></ul></ul></ul><ul><ul><ul><li>145 venue owners interviewed </li></ul></ul></ul><ul><ul><ul><li>282 men and 500 women interviewed in venues </li></ul></ul></ul>- Community Engagement, photo by Shelly Fischer
  10. 10. Community Engagement: Respondent Driven Sampling <ul><ul><li>Opportunity to recruit from hidden/hard to reach population </li></ul></ul><ul><ul><li>An additional debriefing opportunity for participants </li></ul></ul><ul><ul><li>Participants liked privacy of the RDS method </li></ul></ul><ul><ul><ul><li>“Because no one will like other people to know that she decided to participate, for example the way you get me that is the good way.” </li></ul></ul></ul>- A typical Tabora grocery, photo by Shelly Fischer
  11. 11. Behavioral Survey & In-Depth Interviews <ul><ul><li>Areas: </li></ul></ul><ul><ul><ul><li>Demographic Characteristics </li></ul></ul></ul><ul><ul><ul><li>Family Planning and Contraceptive Knowledge </li></ul></ul></ul><ul><ul><ul><li>Family Planning and Contraceptive History </li></ul></ul></ul><ul><ul><ul><li>Willingness to Participate (Factorial Survey) </li></ul></ul></ul><ul><ul><ul><li>Projected Adherence </li></ul></ul></ul><ul><ul><ul><li>Volunteer Counseling & Testing Experience </li></ul></ul></ul><ul><ul><ul><li>Medical History </li></ul></ul></ul><ul><ul><ul><li>Sexual Relationship History </li></ul></ul></ul><ul><ul><ul><li>HIV Prevention Participation Self-efficacy </li></ul></ul></ul><ul><ul><li>Data processing and analyses are in progress </li></ul></ul>
  12. 12. Tabora is a Potential HIV Prevention Research Site <ul><ul><li>Able to effectively recruit large number of women at higher risk of HIV infection </li></ul></ul><ul><ul><li>Target population accepting of future HIV prevention research studies (cohort, gel, pill) </li></ul></ul><ul><ul><li>Skilled staff present at NIMR-Tabora </li></ul></ul><ul><ul><li>General population accepting of research activities </li></ul></ul><ul><ul><li>Local NGO and governmental support </li></ul></ul>- Tabora NGO coordination center, photo by Shelly Fischer
  13. 13. Potential Social-Behavioral Barriers for HIV Prevention Research <ul><ul><li>Male misunderstanding of research </li></ul></ul><ul><ul><ul><li>e.g.; husbands, bar owners </li></ul></ul></ul><ul><ul><ul><ul><li>“ Most of them [men] will think negatively if women participate [in studies] they [women] can have HIV check up and by doing so the men would not trust them.” </li></ul></ul></ul></ul><ul><ul><li>Misconceptions regarding pills/gel </li></ul></ul><ul><ul><ul><li>Rumors regarding the purpose and origin of products </li></ul></ul></ul><ul><ul><ul><ul><li>“… [the gel] has the aim of killing people, hence reducing the number of populations, as well as destroying the reproductive system.” </li></ul></ul></ul></ul>- A typical home in Tabora, photo by Shelly Fischer
  14. 14. Potential Social-Behavioral Barriers for HIV Prevention Research (cont.) <ul><ul><li>Concerns regarding pills/gel </li></ul></ul><ul><ul><ul><li>Keeping products in “safe” place, away from children </li></ul></ul></ul><ul><ul><ul><ul><li>“I would keep it away from my children and put in a safer place.” </li></ul></ul></ul></ul><ul><ul><li>Stigma for those women who are participating – Need to keep participation secret </li></ul></ul><ul><ul><ul><ul><li>“People can say that the ones who use these drugs are already infected.” </li></ul></ul></ul></ul>- A typical home in Tabora, photo by Shelly Fischer
  15. 15. Mechanisms for Successful Community Engagement in Tabora <ul><ul><li>Capitalize on existing relationships between NIMR-Tabora and community leaders </li></ul></ul><ul><ul><li>Conduct formal and informal outreach activities with local stakeholders </li></ul></ul><ul><ul><li>Use local networks to provide access to hard to reach populations </li></ul></ul><ul><ul><ul><li>Learn about the dynamics of where you are recruiting participants </li></ul></ul></ul><ul><ul><ul><li>NGOs working with target population </li></ul></ul></ul><ul><ul><ul><li>RDS recruitment </li></ul></ul></ul>- NIMR Staff Training, photo by Kavita Coombe
  16. 16. Next-Steps for Tabora’s HIV Study Preparedness <ul><ul><li>Address male misconceptions of HIV prevention research </li></ul></ul><ul><ul><ul><li>Provide research literacy programs </li></ul></ul></ul><ul><ul><ul><ul><li>Increase the understanding locally implemented research (e.g., malaria – treated bed nets) </li></ul></ul></ul></ul><ul><ul><li>Enhance laboratory capacity within NIMR-Tabora </li></ul></ul><ul><ul><li>Conduct a cohort HIV incidence study </li></ul></ul>- Typical home in central area of Tabora, photo by Kavita Coombe
  17. 17. Thank You - NIMR Staff, photo by Dominick Shattuck