Despite 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.
We 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.
There 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.
The 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.
Sensalire S, Kaggwa M, Byansi DB, Akinyemi Z, Kutanwa AN. Innovative approaches for preventing HIV among adolescent girls in Uganda: evidence from an evaluation study on anti cross generation sex in secondary schools. J AIDS. 2014. https://doi.org/10.17303/jaid.2014.3027.
Ministry of Health (MOH) [Uganda] and ORC Macro. Uganda HIV/AIDS Sero-behavioural Survey 2004–2005. Calverton, Maryland, USA: Ministry of Health and ORC Macro.
World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva, Switzerland; 2013.
Swartz L, Kagee A, Kafaar Z, et al. Social and behavioral aspects of child and adolescent participation in HIV vaccine trials. J Int Assoc Physicians AIDS Care (Chic). 2005;4(4):89–92. CrossRef
Jackson CA, Henderson M, Frank JW, Haw SJ. An overview of prevention of multiple risk behavior in adolescence and young adulthood. J Public Health (Oxf). 2012;34:i31–40. CrossRef
Background: Lord’s Resistance Army. https://www.theguardian.com/World/LRA. Accessed 20 Oct 2007.
Office of global partnerships. State of Global Partnerships Report. US Department of State, 2017. https://www.state.gov/s/partnerships/releases/reports/2017/268159.htm. Accessed 6 Mar 2017.
Sensalire S, Buyungo, P, Kabasomi B, Mpanga S. Evidence of an emerging practice: integrating the basic care and prevention package (BCP) into care and treatment services for HIV-positive people in Uganda. Sixth IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome, abstract 2011: WePDD0101.
Voluntary medical male circumcision for HIV prevention. http://www.who.int/hiv/topics/malecircumcision/factsheet/en. Accessed Jul 2012.
Kerrigan D, Wirtz A, Semini I, N’Jie N, Stanciole A, Butler J. The global HIV epidemics among sex workers. Washington DC: The World Bank; 2012. CrossRef
Coates TJ, Richter L. Behavioral strategies to reduce HIV transmission: how to make them work better. Lancet. 2008;372(9639):p669–84. CrossRef
- Quality improvement as a framework for behavior change interventions in HIV-predisposed communities: a case of adolescent girls and young women in northern Uganda
Alfred O. Awio
- BioMed Central
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