Barcelona 2013
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| Abstract #444 - Prevention | ||||
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Session: 24.7: Prevention (Parallel) on Tuesday @ 11.00-13.00 in Teatre Chaired by Cate Hankins, Juanse Hernandez Authors: Presenting Author: Dr Joanne Otis - Universite du Quebec a Montreal, Canada |
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| Additional Authors: Mr Henry Luyombya, Dr Eleanor Maticka-Tyndale, Dr Alan Li, Dr Josephine Wong, Dr Kenneth Fung, | ||||
| Aim: The objective was to identify contextual factors that influenced the implementation of two models for rapid HIV testing, in order to optimize the transfer of this intervention to other contexts. Both models were offered to men who have sex with men (MSM) by community organizations in France and Canada. | ||||
| Method / Issue: A case study methodology was used. The first case is the SPOT project, implemented in Montreal in 2009-2012 (N=1739), providing free, anonymous rapid HIV testing in a non-medicalized community-based site. Counselling was done by community workers and testing was provided by nurses. The second case is the ANRS-DRAG project, implemented in four voluntary counselling and testing (VCT) centres in France in 2010-2011 (N=343). Rapid HIV testing and counselling were offered by community workers during and outside of regular opening hours. After each appointment, the intervention staff filled out a logbook to record the degree of implementation (DI) for each task in the protocol. Content analysis was done on data collected during interviews with intervention staff as well as on the comments they included in the logs. | ||||
| Results / Comments: Despite organizational differences, overall DI is similar and high for SPOT and DRAG cases: 88.8±10.1% and 81.3±17.7%, respectively. Regardless of country, highest DI scores were for tasks related to the administration of the rapid test (SPOT : 93.7±9.9%; DRAG : 97.2±15.6%). A greater variation in DI observed at DRAG can be explained by the fact that testing was done by community workers rather than by nurses in SPOT. For both cases, DI related to pre-test (PreC) and post-test counseling (PostC) were acceptable, but lower (SPOT : PreC = 79.3±24.6% and PostC = 84.0±17.5%; DRAG : PreC = 78.4±36.1% and PostC= 78.3±20.5%). These variations can be explained by contextual factors that were common to both cases. On an individual level, staff motivation, knowledge of the gay community, degree of empathy, listening skills and consistency of their involvement in the project were factors that optimized implementation. However, users who presented with a high level of anxiety regarding their result and those less willing to participate in an open discussion were factors that impaired implementation. On an organizational level, mutual support and guidance among staff members were positive factors, whereas a lack of staff was a factor hindering implementation. On the inter-organizational level, complex interactions between intervention team and organizations responsible for the project were a challenge. For both cases, the research process has had a positive effect on implementation (logbooks as a reminder of key tasks to be completed), but also a negative effect (documents that were too lengthy and too numerous). | ||||
| Discussion: This case study demonstrates the external validity of the implementation of these models of community-based rapid HIV testing for MSM. Future implementation must include various measures: 1) to enhance the involvement of community workers and their capacity to make adjustments in light of users' characteristics; 2) to provide organizational support and ongoing supervision of intervention staff; 3) to ensure effective partnerships between the intervention team and the organizations involved in the project. | ||||
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