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HIV Prevention in Resource Limited Settings: A Case Study of Challenges and Opportunities for Implementation

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International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Sub-Saharan Africa has the highest global prevalence of HIV, and the prevention of transmission between HIV-seropositive and -serodiscordant sexual partners is a critical component of HIV prevention efforts. Behavioral interventions that have demonstrated efficacy in reducing risk behaviors associated with HIV transmission and infection and have been translated, or adapted, to a variety of settings.

Purpose

This manuscript examined implementation of behavioral interventions within resource limited health care delivery settings, and their adoption and integration within service programs to achieve sustainability.

Methods

The CDC/Partner Program, an evidence-based risk reduction intervention, was implemented in Community Health Centers (CHCs) in Zambia using a staged technology transfer process, the Training the Trainers Model. Provincial workshops and training workshops on the provision of the intervention were used to establish a cadre of trainers to provide on-site intervention facilitators capable of ultimately providing coverage to over 300 CHCs.

Results

CHC staff provided the intervention to clinic attendees in four provinces over 4 years while also training new facilitators. The implementation process addressed multi-level issues within the context of training, consultants, decision making, administration, and evaluation as well as practical considerations surrounding travel, training, staff compensation and ongoing quality assurance.

Conclusions

The majority of challenges to implementation and maintenance were addressed and resolved, with the exception of structural limitations related to restricted resources for personnel and funding. Strengths of the program included its collaborative structure, active program leadership, commitment and support at the provincial level, the use of task shifting by existing clinic staff, the train the trainer model and ongoing quality control. Enhanced infrastructure is needed in for future implementation, such as training centers within each province, certified expert coaches and annual workshops and system changes to ensure available staff.

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Acknowledgements

We gratefully acknowledge the contribution of the CDC/Partner team: Miriam Mumbi, Mary-cheer Sinyinda, Gilbert Chitu, Dorothy Mwambaza, Romanus Mphande, Irene Chituwo, Rosemary Banda and Emmanuel Zulu. This study was supported through a cooperative agreement between the Zambia Centers for Disease Prevention and Control and the University Teaching Hospital of the University of Zambia School of Medicine, PD: N. Chitalu, 1U2GPS00049, and preliminary studies were supported by grants from the National Institutes of Health; S. Weiss, PI: R01MH63630; D. Jones, PI: R24HD43613, R01HD058481.

Ethics statement

All procedures followed were in accordance with the ethical standards associated with the Helsinki Declaration of 1975, as revised in 2000, concerning human rights and informed consent. All procedures concerning the treatment of research participants were in accordance with the ethical standards of the Institutional Review Board of the University of Miami Miller School of Medicine and the Research Ethics Committee of the University of Zambia.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Suite 404A, Miami, FL, 33136, USA

    Deborah Jones & Stephen Weiss

  2. University Teaching Hospital, University of Zambia School of Medicine, Kalundu, Lusaka, Zambia

    Ndashi Chitalu

Authors
  1. Deborah Jones
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  2. Stephen Weiss
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  3. Ndashi Chitalu
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Corresponding author

Correspondence to Deborah Jones.

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Jones, D., Weiss, S. & Chitalu, N. HIV Prevention in Resource Limited Settings: A Case Study of Challenges and Opportunities for Implementation. Int.J. Behav. Med. 22, 384–392 (2015). https://doi.org/10.1007/s12529-014-9397-3

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  • DOI: https://doi.org/10.1007/s12529-014-9397-3

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