AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #231 - How participatory research changes and enriches a planned Phase II coping intervention (Project TALC) trial: Study implementation among parents with HIV and their teens living in Zimbabwe
Authors: Presenting Author: Dr Danuta Kasprzyk - Battelle/University of Washington
Additional Authors: Dr. Daniel Montaño, Dr. April Greek, Dr. Sally Nyandiya Bundy, Mr. Stephen Machokoto, Ms. Norest Beta, Mr. Tinashe Muromo, Ms. Rachel Gatsi,
Aim: Project TALC (Teens and Adults Learning to Communicate), a family-focused intervention reduces psychosocial consequences of HIV/AIDS, improving coping in US families, with long-term positive effects. Our goal was to adapt and implement this efficacious intervention among families living with an HIV+ parent, and their adolescent children in Zimbabwe.
Method / Issue: To adapt Project TALC to Zimbabwe a community-based participatory approach was used. The community was engaged via identifying families with 12-18 year old children through a multi-step process. HIV+ individuals and their children were accrued into a Phase II cohort study to assess intervention efficacy.
Results / Comments: Formative research adapted the intervention and pretested all study methods and the adapted, translated (into Shona and Ndebele) TALC intervention. Research included piloting of procedures and instruments with 611 Census families, 145 Health screening families with 12-18 year old children (299 individuals), where we identified 21 HIV+ parents, and in-depth interviews (IDIs) with 36 HIV+/HIV- individuals, documenting HIV/AIDS related psychosocial impact and needs. 5 HIV+ adults pretested the intervention (the Parent Intervention Programme [PIP]).
Discussion: After community engagement, families cooperated with the participatory approach. In the pilot, high uptake of screening showed community-based HIV testing was 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. The upcoming Phase II Trial design, with a no-intervention control was explained to community members. Suggestions from community members resulted in a change of the Trial design to create a second intervention and implement a Comparative Effectiveness Trial (CET), comparing two intervention arms, the TALC coping arm and a capacity arm focusing on business skills requested by the community. Intervention pilot results showed individuals 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. After the formative and pilot phase, the CET was launched with a Census in 4 urban areas to identify families with 12-18 year olds, a Health Screening to identify HIV+ parents of 12-18 year olds. Over 1400 individuals were identified as eligible for accrual into the cohort. 1007 individuals provided Baseline results. Post Baseline, families were randomly assigned to intervention or comparison groups. 717 individuals attended 14 (for adults) or 10 (for adolescents) intervention sessions—in either the Coping or Capacity arms. Follow-up data were collected from individuals who did and did not participate in the intervention, at three longitudinal time points. Three groups of individuals will be compared on their results from the Baseline and follow-ups targeting coping and communication skills. These groups allow us to compare Coping, Capacity, and “Natural Control (individuals who did not attend intervention sessions)” groups of individuals and will be presented in the following papers.
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