Abstract #383  -  Overview of formative research to adapt project TALC: A brief summary of results and lessons learned in the pilot/formative phase
Authors:   Presenting Author:   Ms. Rachel Gatsi - University of Zimbabwe
Additional Authors:  Dr. Sally Nyandiya-Bundy, Mr. Stephen Machokoto, Ms. Norest Beta, Mr. Tinashe Muromo, Dr. Mufuta Tshimanga, Dr. Daniel Montano, Dr. Danuta Kasprzyk,
Aim: Project TALC (Teens and Adults Learning to Communicate), a family intervention, by Rotheram et.al (UCLA) reduces psychosocial consequences of HIV/AIDS, improving coping in US families, with long-term positive effects.
Method / Issue: To adapt Project TALC to Zimbabwe for HIV+ parents, a community-based approach was used with a census to identify families with 12-18 year old children, and adults with HIV via a Health Screening. HIV+ individuals and their children would be accrued into a cohort study to assess the impact of the intervention. Formative research was used to adapt the intervention, and a pilot pretested all study methods, and the adapted, translated TALC intervention.
Results / Comments: As part of the pilot: 321 housing units were censused, enumerating 611 families. 145 (24%) had 12-18 year old children; 195 adults’ and 104 children’s health status was assessed with a WHO AIDS Symptom Checklist. 157 adults (81%) were HIV tested by Zimbabwe’s Rapid HIV Test algorithm. QC showed 100% concordance with a 64% sample using lab-based HIV ELISAs. 23 individuals were HIV+ (10% of families). In-depth interviews (IDIs) with 36 HIV+/HIV- individuals showed psychosocial impact and needs related to HIV/AIDS. 5 HIV+ individuals joined a pretest of the intervention.
Discussion: Families cooperated with the community-based approach. High uptake of screening showed community-based HIV testing is acceptable. Adults agreed psycho-social needs are not met among PLWHA. Parents felt children aged 16+ are old enough to deal with HIV/AIDS issues and information, but rarely reveal HIV status to them. Parents interviewed would like to talk to teens about HIV, but felt youth were getting information from other sources. Parents agreed discussing HIV status was difficult; were hesitant to bring it up, though felt it was important. All were positive about an intervention to help them deal with HIV-associated issues with teens. Half the sample felt modules should be mixed-gender, but half said females would not be so open in those sessions. TALC was originally designed assuming parents disclosed HIV status to children. In Zimbabwe, this was not the case. The intervention had to be adapted to accommodate this. Parents do not disclose HIV status for fear of stigmatization, unnecessarily disrupting children’s lives, and that children may disclose the information. Secrecy still surrounds the AIDS epidemic in Zimbabwe. Teens were ready for an intervention, feeling that they need to be informed and can help. Often teens assume a parent has HIV if a parent becomes ill, so their fears may be worse than reality. Pretesting the intervention showed it was popular, acceptable, and well-received. Individuals in the intervention pilot felt they had learned new coping skills, were motivated to disclose their status to someone close, sought care by going for CD4 testing, an entrée requirement into AIDS treatment. Next Steps: After the formative and pilot phase, the trial was launched with a Census in 4 urban areas, Health Screening, identification of families, accrual into a cohort, with a Baseline conducted. Post Baseline, families were randomly assigned to intervention or control groups.
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