An evaluation of a study driving project resources to under-served populations at risk of HIV: Migrant and disabled adolescent girls and young women

Young women are at significant and disproportionate risk compared to their male counterparts in South Africa. Many foreign migrant and disabled AGYW face heightened risk of HIV in this context. Social isolation and exclusion can amplify structural drivers and risk factors for these sub-populations. Community Media Trust (CMT) is implementing a protective asset building project directed to reach these two under-served AGYW populations. The intended outcome of the CMT project is that migrant and disabled AGYW increase their protective assets, resilience, and coping strategies so they can remain in school.

The overall goal of the evaluation study is to assess the degree to which project activities build protective assets, resilience, and coping strategies of migrant and disabled AGYW in Durban and Johannesburg. The evaluation design will employ qualitative methods. Focus group discussions and brief socio-demographic questionnaires will be conducted with a sample AGYW participants and their parents.

Participants in this study include approximately 80 migrant and disabled adolescent girls and young women (AGYW) aged 14-19 years, participating in the Community Media Trust (CMT), DREAMS intervention and approximately 20 parents of participating AGYW. The project has completed six FGDs to date, the remaining will be completed in 2018.

SOAR project

This evaluation study will assess the effectiveness of a community-based HIV prevention program in informal settlements within KwaZulu-Natal—one of four provinces where the programme is being carried out. The Community Responses intervention is a multifaceted behaviour change intervention using an adapted and scaled version of Stepping Stones. The intervention is designed to promote uptake of HIV and SGBV support services, while also promoting equitable gender norms and a positive enabling environment. The programme targets young men and women living in informal settlements. The Project SOAR evaluation will address a series of important research questions, such as what are the key factors within the informal settlement context that lead to HIV risk behaviours, what level of exposure to an intervention is needed to improve key outcomes, and how to best scale up group education models such as Stepping Stones. Building the global evidence base in this area is vital to improving outcomes related to HIV prevention and eliminating harmful gender norms and SGBV, especially in informal settlements.

Our Research: The study uses a cluster stepped-wedge evaluation design whereby 18 clusters (communities) are randomized to when they initiate the CR intervention. A cohort of approximately 1500 men (aged 18–35) and women (aged 18–24) in evaluation communities will be followed over the course of approximately 30 months. Survey interviews will be completed at baseline and at three additional time points at 7-month intervals. In addition, we will conduct qualitative interviews with programme implementers and a selection of study participants to gain a deeper understanding of the process, experiences, challenges, and benefits of adapting and scaling up the Stepping Stones intervention.

Research Utilization: This study aims to influence the achievement of two key objectives of the South Africa’s National Strategic Plan on HIV—addressing social and structural drivers of HIV and reaching all vulnerable populations with comprehensive services and interventions. To ensure research utilization of findings, the study team continuously engages with key local stakeholders at all stages of the study from inception to dissemination of findings, including the HIV prevention unit of the Department of Health in KwaZulu-Natal Province and nationally; implementers of community-based HIV activities, such as Centre for Communication Impact; and researchers at universities and institutes.

Project SOAR is a five-year (September 2014–September 2019) cooperative agreement funded by the President’s Emergency Plan for AIDS Relief and the U. S. Agency for International Development (Agreement No. AID-OAA-A-14-00060). Population Council leads the Project SOAR consortium in collaboration with Avenir Health, Elizabeth Glaser Pediatric AIDS Foundation, the Johns Hopkins University, Palladium, and The University of North Carolina at Chapel Hill.

Siyaphanta, Siyavimba!

ARV-Based Prevention and Treatment in High-Risk Women in Durban, South Africa

MatCH Research Unit and the HIV Center for Clinical and Behavioral Studies at Columbia University are conducting a study to explore female sex workers’ (FSW) knowledge, attitudes, and experiences with pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), and other prevention options. No one strategy will likely be effective in eradicating HIV among FSW; rather a combination of context-specific targeted strategies, including ARV-based prevention/treatment and condoms, will be needed to reduce HIV incidence. However, combination prevention models for FSW have not been sufficiently developed and tested. This formative, qualitative research study on ARV-based HIV prevention and treatment for FSW will identify the structural, health system, interpersonal and individual-level barriers and facilitators that influence access to, use of, and adherence to ARV-based prevention and treatment among FSWs.

DIFFER: Diagonal Interventions to Fast-Forward Enhanced Reproductive Health

The “Diagonal Interventions to Fast Forward Enhanced Reproductive Health” (DIFFER) research project tests the hypothesis that combining vertical Sexual and Reproductive Health (SRH) interventions, such as services targeted to Female Sex Workers (FSW), with horizontal strengthening of health systems for SRH within existing health facilities, is synergistic, feasible, and likely to be more effective and cost-effective than providing them separately. This multi-country study consists of a consortium of three African, one Indian and two European partners. The research activities are being undertaken in the African sites (Durban, South Africa; Mombasa, Kenya; and Tete, Mozambique) and in Mysore India.

The formative research phase was completed in 2012 and activities included a detailed situational and policy analysis which informed the development of site and context-specific intervention packages to strengthen SRH services. The intervention sought to build FSWs capacity to access much needed SRH and HIV services and assess the feasibility of combining and providing both targeted and horizontal interventions for FSW. The intervention phase ended in March 2016  which was followed up by a comprehensive evaluation exploring empowerment, SRH and HIV healthcare needs, service access and barriers. The study is currently being written up and disseminated.

Acceptability of menstrual Cups in Female Sex Workers in Durban

This was a sub-study within the DIFFER project as part of the intervention to improve the range and quality of Sexual and Reproductive Health (SRH) information and services provided to Female Sex Workers (FSW) in the project catchment area. Menstrual cups were included in the ‘SRH packs’ along with other materials, condoms and pregnancy test kits. Some FSW participated in the mcup acceptability component and gave the project team regular feedback on use and experience with the device.

AYAZAZI: Investigating Patterns of Behavioural and Biomedical Risk for HIV Acquisition and Vaccine Trial Preparedness among Adolescents and Young Adults in a Priority Setting

This study developed a cohort of adolescents and young adults in Soweto and Durban aged between 16-24 (AYA) who were either known to be HIV negative or did not know their HIV status. The  study aimed to   identify, understand and link socio-behavioural, clinical, and biomedical patterns of risk for HIV acquisition and vaccine trial preparedness using a mixed method approach. The study was completed in 2017 and dissemination and write up of the results is in progress.

Click on the image below to see a video on the AYAZAZI study.