Unpacking the care cascade: Late presentation to care among HIV-infected drug users in a large urban center of Brazil

Abstract

Findings: Data from 63 unique study participants, including 27 individual interviews and five separate focus groups, were analyzed. Major themes supported the effectiveness of community-based prevention strategies in community uptake of key messages. Successful approaches for targeting reticent subpopulations included enlisting support from religious leaders and village elders to secure trust from community members. Bidirectional, dynamic methods of communication were also identified as essential characteristics of behaviour change, rather than relying on static materials such as informational posters and pre-taped PSAs. Messages focusing on the lethality of disease were found to reduce essential care-seeking behaviours. Interpretation: Local Red Cross volunteers and staff are ideally placed for social mobilization efforts to prevent transmission, combat misinformation in the event of an Ebola outbreak. They often have an established relationship with community members and understand the anthropological background, which can be a challenge for incoming foreign aid workers. The community-based work of this cadre is an essential component of the response effort complementary to the clinical work. Findings and lessons learned from this research provide the groundwork for continuing response efforts, as well as for future Ebola and infectious disease outbreaks in similar international settings. Funding: The study was supported by funding from IFRC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of its sponsors. Abstract #: 02CD007