HIV Risk Reduction Intervention for Rural Adolescents in Malawi.

Malawian adolescents are at risk for HIV infection. Using a quasi-experimental two group research design, we determined the efficacy of Mzake ndi Mzake Kuunikira Achinyamata (MMKA) in enhancing 13-19 year old Malawian males' and females' HIV knowledge, attitude about HIV, self-efficacy for condom use and for safer sex, and HIV risk reduction behaviors. The regression analyses revealed that compared to their cohorts in the control community, the adolescents in the MMKA community had significantly better scores on the outcome variables. The intervention had significant benefits for male and 16-19 year old adolescents, but not for 13-15 year old female adolescents. Tailored interventions are needed for these females.

Changes in clients' care ratings after HIV prevention training of hospital workers in Malawi.

OBJECTIVE: To examine the changes in clients' health-care ratings before and after hospital workers received an HIV prevention intervention in Malawi, which increased the workers' personal and work-related HIV prevention knowledge, attitudes and preventive behaviors. DESIGN: Pre- and post-intervention client surveys. SETTING: A large urban referral hospital in Malawi. PARTICIPANTS: Clients at purposefully selected inpatient and outpatient units on designated days (baseline, n = 310 clients; final, n = 683). INTERVENTION: Ten-session peer-group intervention for health workers focused on HIV transmission, personal and work-related prevention, treating clients and families respectfully and incorporating HIV-related teaching. MAIN OUTCOME MEASURES: Brief face-to-face clients' interview obtaining ratings of confidentiality of HIV, whether HIV-related teaching occurred and ratings of service quality. RESULTS: Compared with baseline, at the final survey, clients reported higher confidence about confidentiality of clients' HIV status (83 vs. 75%, P < 0.01) and more clients reported that a health worker talked to them about HIV and AIDS (37 versus 28%, P < 0.01). More clients rated overall health services as 'very good' (five-item mean rating, 68 versus 59%, P < 0.01) and this was true for both inpatients and outpatients examined separately. However, there was no improvement in ratings of the courtesy of laboratory or pharmacy workers or of the adequacy of treatment instructions in the pharmacy. CONCLUSIONS: HIV prevention training for health workers can have positive effects on clients' ratings of services, including HIV-related confidentiality and teaching, and should be scaled-up throughout Malawi and in other similar countries. Hospitals need to improve laboratory and pharmacy services.

Outcomes of an HIV prevention peer group intervention for rural adults in Malawi.

This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.

Peer group intervention reduces personal HIV risk for Malawian health workers.

PURPOSE: To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi. DESIGN: Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection. METHODS: The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences. FINDINGS: Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors. CONCLUSION: The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention. CLINICAL RELEVANCE: Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.

Improving universal precautions and client teaching for rural health workers: a peer-group intervention.

Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.

Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi.

Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.

Impacts of a peer-group intervention on HIV-related knowledge, attitudes, and personal behaviors for urban hospital workers in Malawi.

This report describes the effects of a peer-group intervention on Malawian urban hospital workers' HIV-related personal knowledge, attitudes, and behaviors. More than 850 clinical and nonclinical hospital workers received the intervention. Evaluation used independent surveys of a sample of workers at baseline (N = 366) and postintervention (N = 561). Compared with the baseline survey, after the intervention, workers had higher knowledge of HIV transmission and prevention; more positive attitudes including more hope, less stigmatization of persons with HIV, more positive attitudes toward HIV testing and condom use, and higher self-efficacy for practicing safer sex and for community prevention; more reported recent personal HIV tests, more discussion of safer sex with partners, and more reported community HIV prevention activities. However, health workers' risky sexual behaviors did not differ at baseline and postintervention. The intervention should be strengthened to support more sexual risk reduction and be made available to all health workers in Malawi.

Research brief: community consultation to develop an acceptable and effective adolescent HIV prevention intervention.

HIV prevention for adolescents is urgently needed in Africa, but interventions have been slow to develop because of controversies about sex education. In this report the authors describe a four-step process used to develop a culturally and developmentally appropriate adolescent HIV prevention program for communities in rural Malawi. This is the final component of a 2-year ongoing adult HIV prevention program in Malawi. First the authors identified the risky behaviors of rural adolescents as well as cultural, developmental, and contextual factors. Next they consulted the community regarding how to use this information effectively and acceptably. Then an existing intervention was adapted based on this information. Finally, the authors piloted the intervention and made modifications based on lessons learned. This process provides a systematic way to consult with the community, thereby jointly enriching understanding, engaging the issues, and promoting support for an intervention program.

Short-term effects of a peer group intervention for HIV prevention among trainee teachers in Malawi.

This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. Group leaders were teachers selected by each group, and after training they facilitated the peer group intervention. The teachers completed a pre-test and post-test questionnaire. The 286 trainee teachers whose pre- and post-test samples could be matched, largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.

Risky sexual behaviors of adolescents in rural Malawi: evidence from focus groups.

Little is known about rural Malawian adolescents' perceptions of their sexual behavior and what would constitute an effective HIV risk-reduction program. This study explored the perceptions of Malawain adolescents using qualitative description research with focus groups. A purposive sample of 144 adolescents, ranging from 10 to 19 years of age was obtained. Subjects were then placed in focus groups separated by gender Qualitative content analysis revealed that adolescents were at risk for HIV based on the select behaviors These included early sexual debut, multiple partners, non-use of condoms and among girls older partners These adolescents acknowledged peer pressure and lack of parental supervision as factors that perpetuated these behaviors and identified two components of HIV prevention programs. For example, parental involvement and support for sexual abstinence were among the issues discussed. It is essential that HIV risk-reduction programs create ways of involving parents and of enhancing adolescents' HIV risk-reduction skills by helping them to change peer norms and to develop negotiation and assertiveness skills to in order to resist peer pressure.