Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

Abstract

BackgroundDespite effective biomedical tools, adolescents and young men and women carry the dual burden of high HIV incidence and high morbidity/mortality in South Africa. We integrated community-based participatory research (CBPR) with biomedical interventions to develop a peer-led biosocial intervention for HIV care and prevention in young people living in rural KwaZulu-Natal (KZN).MethodsBetween March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected between 2016 and 2018 into 17 vignettes illustrating the local drivers of HIV. During two participatory intervention development workshops and community mapping, the peer-navigators discussed the vignettes in small groups, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change (ToC). Following a six-month pilot, the peer-navigators used process evaluation data and experience to refine the ToC in a third workshop.ResultsFollowing written and oral assessments 57 of the 108 initially selected participated in the two workshops to discuss the vignettes and co-create the Thetha Nami (talk to me) intervention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to include:· Structured assessment tool to tailor support.· Safe spaces and community advocacy to create an enabling environment for HIV prevention.· Peer-led sexual health promotion to improve self-efficacy and demand for HIV prevention.· Accessible youth-friendly clinical services to improve uptake of HIV prevention.· Peer-mentorship to navigate resources and improve retention in HIV prevention.ConclusionLocal youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention and care.

‘This is what is going to help me’: Developing a co-designed and theoretically informed harm reduction intervention for mobile youth in South Africa and Uganda

“…Although subject to increasing attention, there has been a little empirical investigation into the mechanisms of impact of peer support for improving young people's HIV prevention and treatment outcomes (Grimsrud et al, 2020). The nascent evidence-case indicates the significance of 'connectedness' and the importance of the provision of adequate resourcing for training and supervising peer supporters to sustain the potential considerable gains (Mavhu et al, 2020;Shahmanesh et al, 2020;Wogrin et al, 2021).…”

Addressing the Know-Do Gap in Adolescent HIV: Framing and Measuring Implementation Determinants, Outcomes, and Strategies in the AHISA Network

“…For example, in the Sauti ya Vijana pilot [26,27] and scale up study [28], a multicomponent behavioral/social EBI included components of trauma-informed cognitive behavioral therapy, interpersonal psychotherapy, and motivational interviewing, all unique mental health therapy EBIs focused on achieving specific mental health outcomes. In another multi-component approach, the Thetha Nami study [18] delivered a multicomponent clinical 3). Outcomes measured less commonly included appropriateness (n = 8), adoption (n = 9), sustainability (n = 6), maintenance (n = 5), and penetration [2] (Table 3).…”