This document outlines an adolescent HIV prevention program for schools in Geita district, Tanzania. It describes conducting a 4-year intervention rolling out to all 33 wards and schools. The intervention has two components: a classroom curriculum and a social support network for females. The classroom uses knowledge building, skills training, and self-efficacy approaches. The social support network is designed to provide instrumental, companionship, and emotional support. The research design is quasi-experimental, using pre- and post-testing to evaluate the intervention's effects on knowledge, attitudes, and risk behaviors over time.
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Presentation by Dr Bassam Abu Hamad, Dr Nicola Jones, Prof Sarah Baird and Agnieszka Malachowska at the 4th IAAH MENA region Adolescent Health conference in Egypt
A presentation by Jennifer Seager (George Washington University), Maheen Sultan (BRAC Institute of Governance and Development) at the Webinar on Adolescent Experiences in Chittagong and Sylhet: the support programme and COVID-19 impact
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Background and objectives
This event will showcase a new EJDR special issue that explores adolescent experiences across diverse LMICs, including conflict-affected contexts, drawing on unique mixed-methods data from the GAGE longitudinal study. It will highlight why an intersectional approach is critical to capture adolescents’ diverse and dynamic capabilities, and what the policy and programming implications are to ensure no adolescent is left behind.
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The decline was recorded both amidst BBFSWs (30.2% in 2007 to 19.4% in 2014) and NBFSWs (37.4% in 2007 to 8.6 in 2014)
This decline can be attributed to National programmatic response towards achieving universal access to HIV/AIDS preventions in Nigeria.
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The pictures included in these slide were randomly taking from google pictures. If any copyright laws have been violated, please notify me at maphelamoeketsi@gmail.com
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Putting Children First: Session 3.1.C Mokhantso Makoae - Young adolescents se...The Impact Initiative
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An estimated104,000 children aged 0-14 years are infected with HIV in Kenya.
The HIV prevalence rate of youth aged 15-24 years is 2.1%.
Among adolescents aged 12-14 years, 7% have had sex.
Among young people aged 15-24 years, 66% females and 59% males have had sex.
(KAIS 2012)
Stigma and discrimination associated with HIV & AIDS remains a key barrier to preventing new infections and accessing adequate care, support and treatment among youth.
Misperceptions about HIV transmission modes among the youth still exist despite HIV prevention efforts to provide accurate information on HIV and AIDS to the youth.
Putting Children First: Session 2.4.B Mike Wessells - Strengthening community...The Impact Initiative
Putting Children First: Identifying solutions and taking action to tackle poverty and inequality in Africa.
Addis Ababa, Ethiopia, 23-25 October 2017
This three-day international conference aimed to engage policy makers, practitioners and researchers in identifying solutions for fighting child poverty and inequality in Africa, and in inspiring action towards change. The conference offered a platform for bridging divides across sectors, disciplines and policy, practice and research.
Similar to Geita District Mwanza Region Northern Tanzania April 2007 J Sheldon (20)
The Community Tool Box has been working with its Iranian partners who are providing training on policy matters for NGO leaders and advocates based in Iran with the goal of strengthening their skills in policy making and capacity building. As a trainer I prepared and delivered a 60 minute on-line (GoToWebinar) audio lecture on operational planning for policy development or policy change. The Power Point lecture was translated into Farsi and will be broadcast to the Iranian audience at a later date.
The Community Tool Box has been working with its Iranian partners who are providing training on policy matters for NGO leaders and advocates based in Iran with the goal of strengthening their skills in policy making and capacity building. As a trainer I prepared and delivered a 60 minute on-line (GoToWebinar) audio lecture on strategic planning for policy development or policy change. The Power Point lecture was translated into Farsi and will be broadcast to the Iranian audience at a later date.
Geita District Mwanza Region Northern Tanzania April 2007 J Sheldon
1. Before It's Too Late 1
Before it’s too late:
An adolescent HIV Prevention programfor Geita district,
mwanza region, Northern Tanzania
Jeffrey Sheldon, M. A., Ed. m.
School of Behavioral & Organizational Sciences
Claremont Graduate University
The Claremont Colleges
25 April 2007
2. Before It's Too Late 2
OVERVIEW
• SPECIFIC AIMS: global
• SPECIFIC AIMS: students
• BACKGROUND AND SIGNIFICANCE
• TARGET POPULATION
• PRIOR INTERVENTIONS WITH ADOLESCNENTS
• THEORETICAL RATIONALE
• THE INTERVENTION
• THE SETTING
• RESEARCH DESIGN
• METHODS
• MEASURES & evaluation
• CHALLENGES
• TIMELINE
• REFERENCES
3. Before It's Too Late 3
Specific Aims: global
• help meet target of 25 % reduction in hiv prevalence in young people by 2010.
• Put HIV prevalence and risk in a different perspective within the community.
• Provide accurate information that dispels myths and inaccuracies about hiv/aids.
• Begin changing prevalent social norms and prevalent male attitudes towards women.
(Hayes et al., 2005; UNGASS, 2001)
4. Before It's Too Late 4
Specific Aims: students
• know, understand, and be aware of their own bodies.
• know, understand and be aware of developmental stages (physical, emotional, cognitive).
• know how hiv is transmitted and how hiv becomes aids if left untreated.
• know how to decrease their risk of becoming hiv infected.
• know the consequences of risky sexual behavior and alcohol and drug use are associated
with risky sexual behavior.
5. Before It's Too Late 5
Specific Aims: students
• know that oro-genital and anal sex are not safe sexual alternatives.
• know that positive and mutually fulfilling relationships can exist within a context of male
hegemony and dominance.
• be able to properly use male or female condoms.
• know where and how to acquire condoms.
• Begin to change gender role norms and stereotypes through improved female – male
dialogue.
6. Before It's Too Late 6
Specific Aims: students
• Increase adolescent male awareness that females are part of the sexual decision-making
process.
• Attenuate potential adolescent male aggressiveness and hostility towards females.
• Improve self – control in both adolescent males and females.
• Improve male – female relationships through relational skill building.
• Improve communication and negotiation skills between adolescent males and adolescent
females.
7. Before It's Too Late 7
Specific Aims: students
• Increase adolescent female awareness of choice in sexual behavior and risk taking.
• Increase self-efficacy and self-esteem.
• Establish supportive relationships between adolescent females and older, significant – other
females in their ward.
• Establish a social support network between adolescent females across villages in each ward.
• Increase adolescent female coping motives.
8. Before It's Too Late 8
Background& Significance
• Life expectancy in tanzania 44 years and falling; infant mortality rate is 99/1000 and rising
due to high rates of hiv/aids infection – women most at risk.
• 2.2 million people living with hiv/aids:
– 15 % are 15 – 24 years;
– 70.5 % are 25 – 49 years;
– 60 % of new infections in 15 – 24 years age range.;
– 13.3 % infection rate among women and climbing.
• Prevalence rate expected to increase to 16.7 % by 2010 unless…..
(aids and africa, 2003; buve et al, 2002; chnotowa, 1993; ole-nguyaine et al., 2004; somi et al., 2006; tacaids, 2003; unaids, 2004; unicef, 1999)
9. Before It's Too Late 9
Background& Significance
• Hiv infection rates higher in rural areas along truck routes and in mining communities due
to migratory populations.
• Migratory populations engage in more risky behaviors and are considered bridging
populations.
• In geita district, mwanza region 30 companies prospecting for gold.
• Hiv prevalence in geita district 13 %
– 19 % for community members.
– 16 % for women.
(bellaby, 1990; campbell, 1997; cates & dallabetta, 1999; chngalucha et al., 2002; desmond, et al., 2005; republic of tanzania, 1996, 2002)
10. Before It's Too Late 10
target population
• ADOLESCENT FEMALES AND MALES AGES 12 – 18 ATTENDING PRIMARY SCHOOL.
– LIVE IN AN AREA OF HIGH RISK;
– YOUNG WOMEN LIKELY TO ENGAGE IN RELATIONSHIPS WITH OLDER MEN;
– 14 % PREGNANCY RATE FOR ADOLESCENT FEMALES;
– 25 % - 33 % STI RATE IN MALES & FEMALES RESPECTIVELY;
– Males deny risk.;
– Girls have less exposure to accurate information;
– Males and females have different attitudes about sex;
– Knowledge gap between males and females;
– Adolescence a time of experimentation; and
– Male hegemony and dominance is the prevailing cultural norm.
(adamchak et al., 1990; desmond et al., 2005; gesovitz, 2005; gupta & weiss, 1993; haram, 2004, 2005; klepp et al., 1996, 1997; matasha et al., 1998;
nyblade et al, 2003; orubulolye et al., 1993; silberschmidt & rasch, 2001; unaids, 2004; unaids/who, 2002; unicef, 2000; vavrus, 2003)
11. Before It's Too Late 11
prior interventions withadolescents
• AarØ, L. E., et al. (2006). Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania:
Development of a theory and evidence based intervention program. Scandinavian Journal of Public Health, 34, 150 – 158.
• Clark, T. S., et al. (2006). An Adolescent-targeted HIV Prevention Project Using African Professional Soccer Players as Role
Models and Educators in Bulawayo, Zimbabwe. AIDS Behavior, 10, S77 – S83.
• Gallant, M., & Maticka-Tyndale, E. (2004). School-basedHIV prevention programmes for African youth. Social Science &
Medicine, 58, 1337 – 1351.
• Klepp, K.I., et al. (1997). AIDS education in Tanzania: Promoting risk reduction among primary school children. American
Journal of Public Health, 87(12), 1931 - 1936.
• Kaljee, L. M., et al. (2005). Effectiveness of a theory–basedrisk reduction HIV prevention program for rural Vietnamese
adolescents. Aids Education and Prevention, 17(3), 185–199.
• Stanton, B. F., et al. (1998). Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction
intervention: A randomized, longitudinal study. AIDS, 12, 2473 – 2480.
• Visser, M. J., & schoeman, J. B. (2004). Implementing a community intervention to reduce young people’s risks for getting HIV:
Unraveling the complexities. Journal of Community Psychology, 32(2), 145 – 165.
12. Before It's Too Late 12
theoretical rationale
• Knowledge, skill – building, self-efficacy component.
• Protection motivation theory.
– Threat appraisal.
• Intrinsic rewards;
• Extrinsic rewards;
• Perceived severity; and
• Perceived vulnerability.
– Coping appraisal
• Self-efficacy;
• Response efficacy; and
• Response costs.
(rogers, 1975)
13. Before It's Too Late 13
theoretical rationale
• Social support network for adolescent females component.
• Social support theory.
– instrumental
– Companionship
• Leisure activities
– Informational
• Get help in understanding a problem
• Receive advice on methods of coping
– Emotional
• Increases self-esteem because one is loved & accepted
(cohen&willis,1985)
14. Before It's Too Late 14
theintervention
• Interventions for adolescents as espoused in the literature not operating in geita district.
– Geita district council has established hiv/aids committees in all 33 wards.
– A community mapping exercise has been done in 16 wards.
– Two centers for Voluntary counseling & testing.
– Home based care & support available.
– Schools have integrated plans that involve councilors and school committees.
15. Before It's Too Late 15
theintervention
• socio-ecological perspective of working with wards & villages
• builds on existing hiv prevention efforts in the geita district.
• participatory rural appraisal to engage community.
• modification of the focus on kids curriculum within a socio – cultural framework.
• Creating a social support network a novel approach; different than typical peer support
used in schools in other interventions.
(Dalton et al., 2001; edwards et al., 2000; goodman, 1998, 2000; Kaljee et al., 2005; Maalim, 2006; Scheirer, 19996;., Stanton et al., 1998).
16. Before It's Too Late 16
theintervention
• Two components:
– Classroom.
– Social support network for females.
• The classroom component:
– 16, 2 hour sessions over four months.
– Knowledge.
– Skills.
– Self-esteem, Self-efficacy.
• Social Support network component:
– 2 hours per week, 8 hours per month +.
– Instilling and supporting optimism & hope.
– Supporting resistance & negotiation.
– Staving off depression.
17. Before It's Too Late 17
theintervention
• The classroom component curriculum:
– Biological facts, puberty and sexuality;
– Basic facts, reproductive biology;
– Basic facts, adolescent development;
– Basic facts, hiv/aids;
– Risk behaviors including alcohol/drug use;
– Exercising self – control;
– Intra-relationship violence;
– Communication & negotiation skills;
– A framework for decision – making;
– Male – female Relationship skill building;
– Effective & safe birth control / efficacy;
– Readjusting gender roles, power, and sexual relationships; and
– Self-esteem building.
18. Before It's Too Late 18
theintervention
• The Social support component:
– Bring adolescent females together each week to build relationships through shared activities;;
– Establish social support network for adolescent females across villages only during pilot phase;
– Establish social support network for adolescent females across wards during full
implementation;
– Establish social support relationship for adolescent females with older, significant – other female
within villages during both pilot phase and full implementation; and
– monitor and assist in maintaining networks.
19. Before It's Too Late 19
thesetting
• Geita district, mwanza region, northern tanzania
20. Before It's Too Late 20
thesetting
• 33 administrative wards:
– 29 rural, 4 mixed urban/rural.
– 21,582 = Average population / ward.
– 6 = Average # of primary schools / ward.
– 1.5 = average # of government health units / ward.
– 5 = average # villages / ward
• 163 villages.
• 4 tribes: wasukuma, wasumbwa, wazinza, & walongo.
• Population = 712,195 as of 2002 census.
• 234 public primary schools across district; 70 % of children attend primary school.
21. Before It's Too Late 21
RESEARCH DESIGN
• ONE DISTRICT, ALL WARDS, ALL SCHOOLS after 4 YEARS.
• GRADUAL ROLL OUT = 11 NEW WARDS & SCHOOLS THEREIN EACH YEAR.
• COMPARISON SCHOOLS THE PREVIOUS YEAR ARE INTERVENTION SCHOOLS THE NEXT
YEAR.
• YEAR 1: QUASI-EXPERIMENTAL, REGRESSION POINT DISPLACEMENT DESIGN (trochim& campbell,
1996)
• YEARS 2 & 3: QUASI-EXPERIMENTAL, BETWEEN GROUPS, PRE – TEST, REPEATED
MEASURES POST – TEST, DELAYED – INTERVENTION COMPARISON GROUP.
• YEAR 4: QUASI-Experimental, within groups, pre-test, repeated measures post – test, no
comparison.
22. Before It's Too Late 22
Research design
• Year 1, pilot phase
a m j j a s o n d
O1 X1 X1 X1 X1 O1 O1 O1
O2 O2 O2 O2
O3 O3 O3 O3
O4 O4 O4 O4
O5 O5 O5 O5
O6 O6 O6 O6
O7 O7 O7 O7
O8 O8 O8 O8
O9 O9 O9 O9
O10 O10 O10 O10
O11 O11 O11 O11
27. Before It's Too Late 27
methods
• Hire qualified local talent (teachers, community health workers, et al) as facilitators/research
associates; hire in sufficient numbers for full coverage.
• Screen for character, professionalism, desire, motivation, energy.
• Three days of training = 24 hours and on-going professional development
empowerment.
• Facilitators/research associates assist in contextualizing program within the district.
• ALL MATERIALS TRANSLATED INTO SWAHILI.
28. Before It's Too Late 28
methods
• Teachers & community health workers implement curriculum & assist in social support
component with other local stakeholders.
• Use of experiential learning, and skill practice rather than rote learning.
• Multiple, multiple, multiple fidelity checks.
• Multi-tasking by program development team
– data collection (farm out analysis to unwitting grad student);
– fidelity checks;
– training & ongoing professional development;
– monitoring social support networks;
– working with funding agency, community stakeholders, schools, governing authorities,, parents,
wards & individual villages, & students.
29. Before It's Too Late 29
Measures & evaluation
• Quantitative data collected four times per year (April, July, October, & December), same
measures
• Modified Youth health risk behavior instrument (YHRBI)
– Modifications to be factor analyzed and checked for reliability/validity during pilot phase; re-modified
as necessary;
– total items ≈ 175;
– Total time ≈ 45 minutes;
– Small cash incentive in usd;
– English & swahili versions;
30. Before It's Too Late 30
Measures & evaluation
• YHRBI items
– Demographics
– Engagement in violent activities (we may drop this)
– Engagement in tobacco, alcohol, & other drugs
– Past and current relationships
– Engagement in sexual activities
– Use of condoms/other forms of birth control
– Male – female partner communication
– Condom access/birth control access & efficacy
– Attitudes & beliefs regarding hiv/aids
– Perceptions on friends’ engagement in risk activities
– Intentions to engage in risk behaviors
– Hiv/aids knowledge
– Engagement with adults in dialogue about hiv/aids
– Knowledge of anyone with hiv or aids
– Knowledge on biological aspects of puberty, sexuality, reproductive biology, birth control, & safe sex
– Readjusting gender roles, power and sex, intra-relationship violence, sexual decision – making, negotiation
skills, self esteem, self-efficacy, female – male relationship building skills.
31. Before It's Too Late 31
Data analysis
• Pilot data
– A variation of ancova model
– Bivariate pre – post distribution of scores calculated for all groups
– Regression line computed for controls only as model of predicted outcome with specific pre-test
scores
– Test whether displacement of intervention group’s score from control groups’ regression line
significant using 2 – tailed t test
• Full implementation data
– 2 – tailed, Independent sample t tests (years 2 & 3)
– 2 – tailed, Matched sample t tests (year 4)
– anova
32. Before It's Too Late 32
Measures & evaluation
• Qualitative data collected four times per year (April, July, October, & December).
– Semi - Structured interviews.
– Focus groups.
• Content analysis and converting qualitative data into quantitative data (e.g., frequencies).
33. Before It's Too Late 33
Measures & evaluation
• Adolescent female social support networks
– Effectiveness of group meetings and what they got out of them;
– Effectiveness of establishing relationships;
– Efficacy of establishing networks;
– Suitability of network matching;
– Effectiveness of communicating between villages and means of conveyance;
– Topics of discussion and types of support provided;
– Who is in the network;
– Process by which relationships forged;
– Difficulties and ease in networking;
– Durability and stability of relationships/network;
– Frequency of face to face meetings or other communications; and
– Whether networking and relationships helped delay onset of sexual intercourse, resist unwanted
and persistent male sexual advances, or negotiate safe sex.
34. Before It's Too Late 34
Measures & evaluation
• Adolescent female – older significant other support
– Effectiveness of establishing relationship;
– Efficacy of establishing relationship;
– Suitability of match;
– Effectiveness of communicating within village and means of conveyance;
– Topics of discussion and types of support provided;
– Process by which relationship forged;
– Difficulties and ease in meeting;
– Durability and stability of relationship;
– Frequency of face to face meetings or other communications; and
– Whether relationship helped delay onset of sexual intercourse, resist unwanted and persistent
male sexual advances, or negotiate safe sex.
35. Before It's Too Late 35
challenges
• The silence of those in authority
• Traditions that discourage open discussions of sexuality
• Overt & covert resistance to change
• Poverty
• Women’s low social status
• Inaccurate and incomplete information on HIV transmission
• Fears about HIV
• Stigma
• Changing female values
• 4 different ethnic groups
• Working through multiple layers of bureaucracy
• Potential for increases in risk behaviors
• Contamination from mass media campaigns
• Matching intervention groups with controls
• Inconsistent school attendance
36. Before It's Too Late 36
Timeline years 1 - 4
ProgramComponent J F M A M J J A S O N D
Contextualize issues in community through PRA X X X
Hire local teachers and community health workers and provide training X X X
Planning intervention components on the premises of local culture and context; EVALUATION DATA FROM
PREVIOUS YEAR
X X X
Random sampling and recruitment of wards and schools X X X
Obtain informed consent from parents and students X
Biological aspects of puberty and sexuality X
Basic facts about reproductive biology and HIV/AIDS/STI X
Effective and safe birth control and condom use X
Readjusting gender roles, power and sexual relationships, intra-relationship violence X X X X
Risk behaviors associated with HIV/AIDS infection - alcohol consumption, drug abuse X X
Sexual decision-making skill building X X
Self-esteem AND SELF – EFFICACY SKILL building activities X X X X
Male – female communication and negotiation skill building X X X X
Female – male relational skills building X X X X
Establish adolescent female inter-district support network X X X X
Establish older female – adolescent female social support network X X X X
Fidelity Checks and monitoring support NETWORKS F F M M M
Data collection and analysis X a a X a X a a X
37. Before It's Too Late 37
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Saharan Africa. Lancet, 359, 2011 – 2017.
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transmission on the South African gold mines. Social Science & Medicine, 45(2), 273–281.
38. Before It's Too Late 38
references
• Cates, W., & Dallabetta, G. (1999). The staying power of sexually transmitted diseases. The Lancet, 354(S4), 2.
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programme Mwanza Region, NW Tanzania. Sexually Transmitted Infections, 78, 91 – 96.
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Variations of HIV and STI prevalence within communities neighbouring new gold mines in Tanzania importance for
Intervention design. Sexually Transmitted Infections, 79, 307–312.
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