Effect of a values-based prevention curriculum on HIV-positive couples from four regions in Ethiopia Presented at XIX IAC 2012 By Misgina Suba, MPH 25 July 2012
Background • Evidence increasingly reveals that much of the heterosexual HIV transmission in Southern and East Africa takes place within marriage or cohabitation. • The Faithful House (TFH) is a culturally sensitive skills-building HIV prevention program designed to strengthen relationships for cohabitating couples .
Program Description • TFHis a 5-day participatory curriculum developed by CRS and Maternal Life International • Groups of 10-15 couples complete sessions together and as couples • Facilitators guide discussion by the interest and needs of the group
Program Description • Drama, role plays and pictures evoke discussion so literacy is not required • Modified for couples living with HIV and PMTCT programs • CRS has trained facilitators in 12 countries and reached over 79,000 beneficiaries
Study Objective Assess the outcomes of TFH for PLHIV on: • Couples’ communication, quality of relationship • Family strengthening attitudes and behaviors • Couples’ health maintenance behaviors, such as adherence to medication, health visit completion and follow-up
Methodology • Study design: Quantitative and qualitative methods, randomized controlled trial • Study period: June 1 to Sept 30, 2011 • Sample size : 204 couples living with HIV • Data collection : standardized survey by trained enumerator • Comparison: intervention and control at 3 month follow-up
Results: Demographic • 10% of couples were HIV discordant • 99% urban population • 45% cohabiting; 43% traditional marriage • 87% had children; 35% caring for OVC • 46% of males; 68% of females did not complete primary education
Results: Relationship Satisfaction * = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)
Results: Family Indicators * = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)
Results: Health Status • *= statistically significant change (p<0.05) • ^ non adherent defined by three or more missed doses in the last month
Qualitative Results The primary findings from our focus group discussions: TFH helped couples reconcile after disclosure and blame related to the positive diagnosis. 2. TFH provided couples with the skills needed for conflict resolution. Participants in TFH workshop going together for VCT
Study Limitations • Surveys not translated into all the local languages. • No objective data to validate self reported responses • All couple participants were self-selecting, already enrolled in HIV treatment and care services, and only eligible if both partners could attend • Attention bias
Conclusion • TFH has a positive impact on attitudes and determinants of behaviors that affect relationship and physical health. • TFH can be used to encourage male involvement in care of sick children and couple participation in PMTCT and ART programs. • TFH is being evaluated to test its potential use in encouraging female participation in decision making around use of household assets.
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