This document discusses strategies for HIV prevention and retention in care. It describes primary, secondary, and tertiary prevention strategies. It outlines a VCT+ program for confidential HIV screening, CD4 staging, and referral into continuum of care programs. The document also discusses retention strategies applied in communities, including intensive adherence management, childcare, sports, drama, music, and entrepreneurship programs. It presents outcome measures of success in primary, secondary, and tertiary prevention as well as retention for life. Some early results from clinics and outreach programs are shown.

3. HIV- HIV+ CD4<350 VL<50 CD4>250

4. 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

6. 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

8. Retention Strategies Applied in the Community
Intensive adherence management
Childcare program
Sports program
Drama and music
Theatre “The Miracle”
Entrepreneurship
Retention through motivation

9. CHAMP Prevention program
•Community participation
•Family involvement
•Integrated into Social Mobilisation
•Integrated into Primary Healthcare

10. 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

11. Some early results…

12. 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)

14. 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

16. mean of age
0 10 20 30 40
0
Mean Ages
1

17. Sex distribution
0 1
Female 1 Male 2
Graphs by time

18. Thank you
Questions & Discussion