Abstract
BackgroundDespite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in 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 during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307).ResultsFollowing written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me’). The intervention included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were 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 add three components: structured assessment tool to tailor health promotion and referrals, safe spaces and community advocacy to create an enabling environment, and peer-mentorship and navigation of resources to 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.
Highlights
Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people
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”
This is despite highly efficacious and cost-effective HIV prevention tools. These include HIV point-of-care tests (POCT) and self-tests; the use of daily oral tenofovir/emtricitabine for Pre-Exposure Prophylaxis (PrEP), which can reduce the risk of acquiring HIV by up to 90%; voluntary medical male circumcision that reduces the risk for men of acquiring HIV by 60%; and HIV treatment with antiretroviral therapy (ART) that reduces mortality and eliminates onward transmission of HIV to sexual partners [2,3,4]
Summary
HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. This is despite highly efficacious and cost-effective HIV prevention tools These include HIV point-of-care tests (POCT) and self-tests; the use of daily oral tenofovir/emtricitabine for Pre-Exposure Prophylaxis (PrEP), which can reduce the risk of acquiring HIV by up to 90%; voluntary medical male circumcision that reduces the risk for men of acquiring HIV by 60%; and HIV treatment with antiretroviral therapy (ART) that reduces mortality and eliminates onward transmission of HIV to sexual partners [2,3,4]. Concern about young people’s vulnerability to HIV-infection led to the launch of initiatives, such as the DREAMS (determined, resilient, empowered, mentored and safe) partnership that combines social and behavioural interventions to reduce adolescent and youth vulnerability [7] Such initiatives have struggled to accelerate the declines in HIV incidence [8]
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