Abstract #256  -  Implementation of a National Community-Level HIV Prevention Intervention in Rural Zimbabwe: Lessons Learned
Authors:   Presenting Author:   Dr. Danuta Kasprzyk - Battelle - University of Washington
Additional Authors:  Dr. Daniel Montaño, Dr. Danuta Kasprzyk,
Aim: In this presentation, we will discuss the implementation of the Popular Opinion Leader (POL) Model intervention in 30 rural sites around Zimbabwe. We will highlight the barriers and facilitators that impacted its implementation in this real world setting. In addition, we will summarize the lessons learned in the translations and implementation of this nation-wide community-based intervention.
Method / Issue: Community-based interventions are an important aspect of the HIV prevention arsenal and many trials have shown effectiveness of various approaches. Translation or adaptation and implementation of Phase III effectiveness research findings to real world settings, especially in countries with high impact HIV/AIDS epidemics, has rarely been done. As part of a five-country international prevention trial, we implemented the POL intervention in 30 rural sites in Zimbabwe and evaluated its impact. As part of the Zimbabwe Ministry of Health’s prevention implementation priorities, 30 rural sites were chosen for implementation of the POL prevention intervention. Growth point villages, which are Zimbabwe government villages designated for infrastructure development, were selected as intervention sites, as they have been shown via Zimbabwe’s surveillance program to have higher HIV prevalence rates than other locales in Zimbabwe.
Results / Comments: Situational analyses of 65 growth point villages were conducted to assess infrastructure in each site able to support an HIV prevention intervention, its evaluation, and to gauge HIV risks. Thirty sites were then selected for more in-depth formative research. Epidemiological and ethnographic studies were conducted to determine target groups, the reliability of a behavioral risk assessment, whether STD and HIV biological samples (urines, bloods, and vaginal swabs) could be collected and processed and prevalence of HIV risk behaviors and prevalence of HIV and STDs, including Herpes 2, Gonorrhea, Chlamydia, Syphilis, Bacterial Vaginosis. The Data Coordinating Center conducted all country trainings including key staff from the 5 participating countries. In addition, research data collection and ethics trainings were conducted on an annual basis by the Battelle Principal Investigator and co-investigators. Lab techs were trained and monitored by the Johns Hopkins University Reference Lab. Battelle staff were on-site 4-6 times a year.
Discussion: Implementing interventions in developing country settings has many challenges. We were successful in the implementation and evaluation of the POL intervention via active and passive support from in-country institutions and entities. Zimbabwe’s public health and educational infrastructures remain relatively intact, and while those infrastructures have been impacted by the economic climate and hyperinflation, support from public health entities, including the Ministry of Health, close working relationships with in-country colleagues, close ties with academic units, namely the Department of Community Medicine at the College of Health Sciences, allowed us to complete the trial with an overall follow-up rate of over 80%. Study staff were selected on the basis of relevant experience, and training and close monitoring by Battelle scientists was also instrumental in keeping the intervention trial on course and the successful completion of the study. To implement interventions shown to be effective in clinical trails in community settings, multi-level support, commitment to training and monitoring, and building in-country team capacity are all important.
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