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Best community strategies to reduce the incidence of HIV infection

Best community strategies to reduce the incidence of HIV infection. NS 400 University of Alaska Anchorage Savanna Brady, Renee Lindow , Willy Mamtchueng , Harold Sunkel , Janelle VanBuskirk. Background and Significance.

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Best community strategies to reduce the incidence of HIV infection

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  1. Best community strategies toreduce the incidence of HIVinfection NS 400 University of Alaska Anchorage Savanna Brady, Renee Lindow, Willy Mamtchueng, Harold Sunkel, Janelle VanBuskirk

  2. Background and Significance • 30 years after human immunodeficiency virus (HIV) was identified, around 3 million people are still newly infected each year (Ng, et al., 2011) • Despite decades of experience with HIV prevention, the number of people living with HIV continues to rise (Nababan, H., et al., 2011) • In 2010, 4% of the 23 billion dollars that the U.S. Government spent on health care went towards HIV prevention (Miller, et al., 2010) • Mortality rate for HIV worldwide is 25 million since the first case 30 years ago (Merson, et al., 2008)

  3. Searchable Question What are best community strategies to reduce the incidence of HIV infection?

  4. Correlates of participation in a family-based HIV prevention program: Exploring African-American women’s motivations and understanding of the program (Pinto et al., 2007) • Cross-sectional, level IV of evidence. • 227 families (adolescent and their caretakers) • Randomly selected sample, on a purposive population pool. • Researchers measured the attendance of families to CHAMP sessions. • 63% of the families attended the whole session. • Interventions: CHAMP participants appear to be motivated to attend the program because CHAMP fosters community input in all phases of implementation, encourages participants to develop community-based activities related to other social problems, and has an attentive staff that helps participants understand the program Strengths • Large sample • Randomly selected sample Weaknesses • No control group • No mathematical tool to determine the sample size • No clear statement on whether the instrument are valid or reliable. • Limited generalizability

  5. The community-based participatory intervention effect of “HIV-RAAP” (Yancey et al., 2012) • RCT, level II of evidence • African American men and women (18 – 44 years of age) • Convenience sample/ random group assignment • The researchers designed and tested a new tool (HIV-RAAP), coeducational, culture- and gender-sensitive community-based participatory HIV risk reduction intervention. • Intervention effects: reduced sexual behavior risk (P=0.02), improved HIV risk knowledge (P=0.006), and increased sexual partner conversations about HIV risk reduction (P= 0.001). Strengths • Population recruited from the community where identified as high risk • Inclusion criteria • Consistent statistical analysis • Reliable tools ( 0.72< r <0.85) • HIV-RAAP tool was effective, per study result Weaknesses • Unclear validity • Limited generalization • Instrument may have generated biases.

  6. A pilot intervention utilizing internet chat rooms to prevent HIV risk behaviors among men who have sex with men (Rhodes et al., 2010) • Descriptive method, Level VI • Men who have sex with men utilizing internet chat rooms who completed online assessment tool (n=210) • Chat room based intervention providing referral resources and information • Chat rooms should be viewed as a community resource to deliver interventions to communities that may be missed by other interventions Strengths • CyBER educators interacted with more than 1,800 chatters • Provides initial guidance and insight into the development, implementation, and evaluation of chat room- based HIV-prevention intervention • Anonymity of survey taker • Received benefit of teaching even if survey was not taken Weakness • Ethical issues • Generalizability is unclear • Small sample size

  7. Pre-risk HIV-prevention paradigm shift: The feasibility and acceptability of the parents matter! program in HIV risk communities (Miller et al., 2010) • Convenience study, operational research study, Level 3 • 13 sites in HIV at-risk communities in US and Puerto Rico. Parents of youth ages 9-12 (n = 294) • Provided training and materials to implement program • Parents Matter! Program feasible and accepted with overall high satisfaction with activities and materials Strengths • Allowed implementation based on the needs of the site • Surveyed each session both facilitators and parents Weakness • Did not evaluate the effects of the teaching on the adolescents • Time constraints did not mimic real world application • No data collection from participants who did not come to final session

  8. Behavioral strategies to reduce HIV transmission: how to make them work better (Coates et al., 2008) • Systematic Review of descriptive, qualitative, RCT’s & meta-analyses. • Level V evidence • Included 113 studies. • Highly active HIV prevention must include community involvement and scaling up of treatment/prevention efforts. A combination of strategies should be used addressing: behavioral change, pharmaceutical treatment, social justice and biomedical strategies. Strengths • Graphs and tables summarize comprehensive data. • Writer “speaks” with strong conviction. Weakness • No Inclusion/exclusion criteria.

  9. Structural and community-level interventions for increasing condom use to prevent HIV and other sexually transmitted infections (Nababan et al., 2011) • Strengths • Well designed outline for a comprehensive study. • When this much needed study is done, it will fill a gap in the research literature. • Weaknesses • The mix of actual research information with hypothetical information causes confusion. • No actual results, just a call for further study. • Protocol for a systematic review of the topic stated in the title. • Review population: public and at-risk populations. • Condom use remains the keystone of HIV and STI's prevention worldwide. Major barriers: reduction in sexual satisfaction, religion doesn't allow it, availability, accessibility, cost and knowledge deficit.

  10. Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project (Gasiorowicz et al., 2005) • Descriptive, Quantitative, Level IV • 1 session with 362 clients • At least 1 follow up session with 109 clients • Clients receiving multiple counseling sessions showed declining in HIV transmission risk behaviors Strengths • Multiple model assessment of behavior and psychosocial outcomes Weaknesses • Relationship with interviewer may have effected client’s responses

  11. Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection (Review)(Ng et al., 2011) • Systematic review of RCT, Level 1 • Included 4 trials and about 24,000 individuals • No significant effect of STI control to reduce HIV infection Strengths • High level Cochrane Review Weaknesses • Did not account for adjustment of possible confounders by authors

  12. Enhancing community-based organizations’ capacity for HIV/AIDS education and prevention (Mayberry et al., 2009) • Research Study: Quasi-Experimental, Level lll • 24 CBO’s in 9 states • Non-probability, purposive sample • Intervention: Steady increase in CBO’s knowledge scores for problem identification (p=0.047), development of goals and objectives (p=0.045), and development of community level prevention interventions • Strengths: • C-PAS Questionnaire provided simple, non-complex method for gathering data • CBO’s HIV prevention capacity was enhanced • Weaknesses: • CBO’s were awarded funding under $1 million, but still costly • The first questionnaires sent within 2 weeks of each other, not giving much time for change

  13. Behavioral and Biomedical Combination Strategies for HIV Prevention (Bekker et al., 2012) • Literature review, Level VII • Systematic reviews, (theoretical and research) of previous clinical and research studies • Themes: Behavioral strategies, interventions and programs for prevention, Biomedical interventions, Evidence- based practices • Applicable population: Individuals at risk for HIV, HIV researchers • Recommendations: Combination therapies for HIV prevention • Strengths: • The author is an award winning scientist and Dr., considered an expert in biomedical trials and research • Comprehensive view of research studies and successful/ unsuccessful interventions • Weaknesses: • Lower level of evidence because the information was gathered from previous research

  14. Stakeholders • At risk populations • Health care workers • Medical facilities • Public health facilities • Pharmacies • Non-Government Organizations (NGO) • United States Department of Health and Human Services • Center for Disease Control • Educators

  15. Summary of Evidence HIV reduction strategies that work and are supported by evidences: • Condom use remains the keystone of HIV prevention worldwide. Three major barriers must be addressed: • Availability - distribution • Acceptability - education • Accessibility - cost (Nababan et al., 2008)

  16. Summary of Evidence (cont.) • Cyber chat rooms can be used to deliver interventions and education to communities that may be missed by other forms of communication. (Rhodes et al., 2010) • If parents are provided with encouragement, knowledge & skills, they can be an effective intervention for pre-risk (age 9-12) youth. (Miller et al., 2010) • Highly active HIV prevention must include community involvement. Funding sources are encouraged to scale up their efforts. (Coats et al., 2008)

  17. Summary of Evidence (cont.) • Counseling sessions for those engaging in risky behavior was effective for reducing HIV incidence (Gasiorowicz et al., 2005). • A high level Cochran Review conducted in third world countries, found no significant correlation between the reduction of HIV rates and the control of STI’s (Ng et al., 2011) • A research study conducted in 9 southern region U.S. states concluded that HIV education programs increase the development of prevention interventions (Mayberry et al.,2011).

  18. Summary of Evidence (cont.) • Co-ed group therapy where sexual partners attended together enhanced HIV knowledge & prevention (Yancy et al., 2012). • Evidence based devices should be used in the prevention of HIV (Bekker et al., 2012). • Teaching the benefits of HIV prevention, increased attendance at education sessions (Pinto et al., 2007).

  19. Practices Not Supported by Evidence • Population-based biomedical sexually transmitted control interventions for reducing HIV infection (Review) (Ng et al., 2011) • STI control had no significant effect on the reduction of HIV infection.

  20. Most Important Practices to Implement • Condom distribution programs through public health agencies nationwide. • Many at-risk populations such as men having sex with men use the internet as their primary means of communication and education. Internet chat rooms should be used to access these communities with HIV prevention information.

  21. Most Important Practices to Implement (cont.) • Parents of pre-risk (age 9-12) youth should be encouraged and educated in teaching age-appropriate HIV prevention facts to their children. • HIV prevention organizations should take a more holistic approach by encouraging the entire community to get involved and increasing creative fundraising efforts. • Psychosocial counseling should be offered to those who are engaging in HIV risky behavior, including heterosexual and homosexual couples counseling.

  22. Evaluation of Implementations • HIV incidence rates can be used to measure effectiveness of interventions. • Education programs can be evaluated by conducting surveys of condom use and other prevention methods. • The pre-test/post-test method could be used as an outcome measure in some settings.

  23. Results / Conclusion Successful community HIV prevention must be highly active, well funded, and include a combination of interventions. Evidence indicates that cyber chat rooms, psychosocial counseling, and educating parents can be successful. However, condom use is still the worldwide keystone to prevention. Therefore barriers to consistent use of condoms are an extremely important issue for communities to address.

  24. Future Research • The effectiveness of interventions aimed at pre-risk population groups (Miller et al., 2010). • Current level of community education on HIV prevention issues (Yancey et al., 2012). • Causes of constraints limiting HIV prevention (Miller et al., 2010). • Research updated methods of reaching certain populations (Rhodes et al., 2010).

  25. Future Research • A systematic review of condom use in relation to HIV prevention is justified and underway. (Coates et al., 2008). • Effectiveness of interventions aimed at pre-risk populations (Miller et al., 2010). • Current level of community education on HIV prevention (Yancey et al., 2012).

  26. References • Bekker, L., Beyrer, C., & Quinn, T. C. (2012). Behavioral and biomedical combination strategies for HIV prevention . Cold Spring Harbor Perpectives in Medicine, 1-23. • Center for Disease Control and Prevention. HIV in the United States: At A Glance. (2012). Retrieved from http://www.cdc.gov/hiv/resources/factsheets/us.htm • Coates, T. J., Richter, L., & Caceres, C. (2008, August 28). Behavioural strategies to reduce hiv transmission: How to make them work better. Lancet, 372(9639), 669-684. http://dx.doi.org/10-1016/S0140-6736(08)60886-7 • Gasiorowicz, M., Llanas, M. R., DiFranceisco, W., Bentosch, E. G., Brondino, M. J., Catz, S. L.,...Vergeront, J. M. (2005). Reductions in transmission risk behaviors in HIV-positive clients receiving prevention case management services: Findings from a community demonstration project . AIDS Education and Prevention, 17(Supplement A), 40-52.

  27. References (cont.) • Mayberry, R. M., Daniels, P., Yancey, E. M., Akintobii, T. H., Berry, J., Clark, N., & Dawaghreh, A. (2009, January 20). Enhancing community-based organizations’ capacity for HIV/AIDS education and prevention. Evaluation and Program Planning, 32, 213-220. Retrieved from • Merson, M. H., O'Malley, J., Serwadda, D., & Apisuk, C. (2008). The history and challenge of hiv prevention. Lancet, (372), 475-488. • Miller, K. S., Maxwell, K. D., Fasula, A. M., Parker, J. T., Zackery, S., & Wyckoff, S. C. (2010 Supplemental 1). Pre-risk HIV-prevention paradigm shift: The feasibility and acceptability of the parents matter! program in HIV risk communities. Public Health Reports, 125, 38-46. • Nababan, H., Ota, E., Wariki, W. W., Koyanagi, A., Ezoe, S., Shibuya, K., & Tobe-Gai, R. (2011, September 22). Structural and community-level interventions for increasing condom use to prevent HIV and other sexually transmitted infections. Cochrane Database of Systematic Reviews 2011, 11(11). http://dx.doi.org/CD003363. DOI: 10.1002/14651858.CD003363.pub2.

  28. References (cont.) • Ng, B. E., Butler, L. M., Horvath, T., & Rutherford, G. W. (2011). Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection (Review. Cochrane Database of Systematic Reviews 2011, (3). http://dx.doi.org/10.1002/14651858.CD001220.pub3 • Pinto, R. M., McKay, M. M., Wilson, M., Phillips, D., Baptiste, D., Bell, C. C.,...Paikoff, R. L. (2007). Correlates of participation in a family-based HIV prevention program. Journal of Human Behavior in the Social Environment, 15(2-3), 271-289. • Rhodes, S. D., Hergenrather, K. C., Duncan, J., Vissman, A. T., Miller, C., Wilkin, A. M.,...Eng, E. (2010 Supplemental 1). A pilot intervention utilizing internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Reports, 125, 29-37. • Yancey, E. M., Mayberry, R., Armstrong-Mensah, E., Collins, D., Goodin, L., Cureton, S.,...Yuan, K. (2012). The community-based participatory intervention effect of “HIV-RAAP” . American Journal of Health Behavior, 36(4), 555-568.

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