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.
President’s Emergency Plan for AIDS Relief, U. S. Agency for International Development
Dr. Julie Pulerwitz (Population Council), Site PI: Mags Beksinska
MatCH Research Commercial City Site and communities in central Durban and Ugu
In-depth interviews (IDIs) and focus group discussions (FGDs) are being conducted with female participants and IDIs with male partners of the participants in the IPM 027 Ring Study at sites across South Africa. These interviews and discussions will explore issues of adherence and acceptability of the vaginal ring. The MatCH Research Socio-Behavioural Team is conducting the analysis of these IDIs and FGDs.
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. In particular, the research activities will build capacity to implement interventions for FSW. 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 including a detailed situational and policy analysis informed the development of site and context-specific intervention packages to strengthen SRH services. This study is now in the intervention phase and a comprehensive evaluation will follow at the end of 2015.
The European Union
Prof J Smit (MatCH Research)
MatCH Research Commercial City Site and community in central Durban
University of Ghent – International Centre for Reproductive Health (UG-ICRH), Belgium, Ashodaya Samithi (Ashodaya), India, International Centre for Reproductive Health Association, Kenya (ICRH-K), International Centre for Reproductive Health Association Mozambique (ICRH-M), Lifeline, Durban
Safer conception for HIV-infected men choosing to Conceive with At-Risk-Partners: Helping Men Have Healthy Babies (Piloting the intervention)
This project aims to develop a safer conception intervention for HIV-infected men who choose to conceive with at-risk partners. The study has 3 phases. In Phase 1 we recruited HIV positive men from a clinic in Durban who reported desire to have a child in the next year with their HIV-uninfected or HIV status unknown partner. We conducted three focus group discussions in order to obtain feedback on our safer conception intervention for serodiscordant couples exploring perceived effectiveness, feasibility, and acceptability of intervention content, best approaches to maximize recruitment and retention and acceptability and feasibility of SMS messaging to record sexual behaviour.
The study is currently in the planning phase and we are working on Phase 2, an Open Pilot study of the safer conception intervention. In Phase 3 we will conduct a pilot randomised controlled trial of the final safer conception intervention among men who want to have children with uninfected or unknown status partners.
National Institutes of Health via Massachusetts General Hospital
Dr L Matthews (Massachusetts General Hospital ), Prof J Smit (MatCH Research)