Quality improvement as a framework for behavior change interventions in HIV-predisposed communities: a case of adolescent girls and young women in northern Uganda

Abstract

BackgroundDespite the conventional approaches to HIV prevention being the bedrock for early reductions in HIV infections in Uganda, innovations that demonstrate reduction in risk to infection in vulnerable populations need to be embraced urgently. In the past 2 years, a USAID-funded project tested a quality improvement for behavior change model (QBC) to address barriers to behavioral change among adolescent girls and young women (AGYW) at high risk of HIV infection. The model comprised skills building to improve ability of AGYW to stop risky behavior; setting up and empowering community quality improvement (QI) teams to mobilize community resources to support AGYW to stop risky behavior; and service delivery camps to provide HIV prevention services and commodities to AGYW and other community members.MethodsWe recruited and followed a cohort of 409 AGYW at high risk of HIV infection over a 2-year period to examine the effect of the QBC model on risky behaviors. High-risk behavior was defined to include transactional sex, having multiple sexual partners, and non-use of condoms in high-risk sex. We documented unique experiences over the period to assess the effect of QBC model in reducing risky behavior. We analyzed for variances in risk factors over time using repeated measures ANOVA.ResultsThere were statistically significant declines in high-risk behavior among AGYW over the QBC roll-out period (p < 0.05). Univariate analysis indicated reduction in AGYW reporting multiple sexual partners from 16.6% at baseline to 3.2% at follow up and transactional sex from 13.2 to 3.6%. The proportion of AGYW experiencing sexual and other forms of gender based violence reduced from 49% a baseline to 19.5% at follow up due to the complementary targeting of parents and partners by QI teams.ConclusionThe QBC model is appropriate for the context of northern Uganda because it provides a framework for the community to successfully drive HIV prevention efforts and therefore is recommended as a model for HIV prevention in high-risk groups.

Depression, self-concept, future expectations and hope of people with HIV

“…The high prevalence of unprotected sex-confirming the inconsistent use of condoms, as well as the common occurrence of casual sex with multiple partners (15) -also stands out in our study, making it necessary to strengthen the importance of condom use in all cases, in order to prevent sexually transmitted infections.…”

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

“…Moderate youth engagement was identified in six interventions (8%) whereby youth, under supervision, were empowered to decide how to deliver intervention components, implying shared decision making with adults (Video S1 abstract) [22‐27]. Most interventions (48, 65%) had minimal engagement, with youth having no decision‐making power [28‐65,67‐72,75,87,90,130], and some interventions (17, 23%) had no engagement at any phase of research [66,73,74,76‐86,88,89,129].…”

“…Both studies were conducted after 2010. We also assessed of the extent of youth engagement over time by comparing engagement in studies conducted in or before 2010 [19,20,22,23,25‐27,31,33,34,39‐41,45‐48,52‐54,59,60,66,68,72,73,77,78,80,82,83,88,89,109,115,121,130], to studies conducted after 2010 [21,24,28‐30,32,35‐37,42‐44,50,51,56‐58,60,62‐64,67,69‐71,75,76,79,81,84‐86,90,100,110,111,129]. We found youth engagement in 28 out of 37 interventions (76%) conducted in or before 2010, and in 30 out of 37 interventions (81%) conducted after 2010.…”

“…Following our secondary search for studies that described the interventions identified, we found 27 additional manuscripts. Thus, the total number of manuscripts reviewed was 112 [19‐130]. These manuscripts described 74 unique intervention research studies (Table 1) […”

“…The intervention phase had the highest number of interventions with youth engagement (42, 57%) [19,20,22‐34,39,42‐47,49,51‐53,56‐59,61,63‐65,67‐72,75]. There was one intervention study with substantial youth engagement at this phase of research.…”