12 research outputs found
Application of the HIV prevention cascade to identify, develop and evaluate interventions to improve use of prevention methods: examples from a study in east Zimbabwe
Introduction: The HIV prevention cascade could be used in developing interventions to strengthen implementation of efficacious HIV prevention methods, but its practical utility needs to be demonstrated. We propose a standardized approach to using the cascade to guide identification and evaluation of interventions and demonstrate its feasibility for this purpose through a project to develop interventions to improve HIV prevention methods use by adolescent girls and young women (AGYW) and potential male partners in east Zimbabwe. Discussion: We propose a six-step approach to using a published generic HIV prevention cascade formulation to develop interventions to increase motivation to use, access to and effective use of an HIV prevention method. These steps are as follows: (1) measure the HIV prevention cascade for the chosen population and method; (2) identify gaps in the cascade; (3) identify explanatory factors (barriers) contributing to observed gaps; (4) review literature to identify relevant theoretical frameworks and interventions; (5) tailor interventions to the local context; and (6) implement and evaluate the interventions using the cascade steps and explanatory factors as outcome indicators in the evaluation design. In the Zimbabwe example, steps 1-5 aided development of four interventions to overcome barriers to effective use of pre-exposure prophylaxis (PrEP) in AGYW (15-24Â years) and voluntary medical male circumcision in male partners (15-29). For young men, prevention cascade analyses identified gaps in motivation and access as barriers to voluntary medical male circumcision uptake, so an intervention was designed including financial incentives and an education session. For AGYW, gaps in motivation (particularly lack of risk perception) and access were identified as barriers to PrEP uptake: an interactive counselling game was developed addressing these barriers. A text messaging intervention was developed to improve PrEP adherence among AGYW, addressing reasons underlying lack of effective PrEP use through improving the capacity (âskillsâ) to take PrEP effectively. A community-led intervention (community conversations) was developed addressing community-level factors underlying gaps in motivation, access and effective use. These interventions are being evaluated currently using outcomes from the HIV prevention cascade (step 6). Conclusions: The prevention cascade can guide development and evaluation of interventions to strengthen implementation of HIV prevention methods by following the proposed process
âLow-hanging fruitâ: Counting and accounting for children in PEPFAR-funded HIV/AIDS programmes in South Africa
Creating Change Through Collaboration: A Twinning Partnership to Strengthen Emergency Medicine at Addis Ababa University/Tikur Anbessa Specialized Hospital-A Model for International Medical Education Partnerships
Financial education for HIVâvulnerable youth, orphans, and vulnerable children: A systematic review of outcome evidence
HIV Risk in Group Sexual Encounters: An Event-Level Analysis from a National Online Survey of MSM in the U.S.
Application of the HIV prevention cascade to identify, develop and evaluate interventions to improve use of prevention methods: examples from a study in east Zimbabwe
The Context of Condom Use Among Young Adults in the Philippines: Implications for HIV Prevention
Identifying âcorridors of HIV transmissionâ in a severely affected rural South African population: a case for a shift toward targeted prevention strategies
Compassion Technology: Life Insurance and the Remaking of Kinship in Swaziland\u27s Age of HIV
An emergent life insurance market in Swaziland is prompting some families to remake kinship as the entrustment of a generation of deceased relativesâ children. Coincident with high HIV/AIDS mortality and changing economic policies for the financial services sector, Swaziland saw an influx of foreign insurance companies in the early 2000s. Those companies offered incentives like burial coverage and cash stipends, and they compelled familiesâ legal adoption of children as orphans through the state, an ambiguous contrast to customary child entrustment and caregiving practices. I offer ethnographic insight on financialization in the global South and conceptualize insurance as a biopolitical, moralized âcompassion technology,â which enveloped personsâ financial-legal obligations within humanitarian and global health discourses of social regeneration