A Peer Education Program for Taxicab/Tricycle Drivers and Other Bridge Populations

Investigators: Donald E. Morisky, ScD, ScM, MSPH, Chrystene Nguyen, MPH, Alfonso Ang, PhD, & Teodora V. Tiglao, EdD, MPH

The Peer Education Program aims to decrease sexual risk behaviors (such as unprotected sex) among members of a .bridge. population who are at risk of spreading STIs including HIV between high-risk groups (e.g., commercial sex workers) and the general population (e.g., other sexual partners). The Peer Education Program demonstrated increases in knowledge of HIV/AIDS transmission, positive attitudes toward condom use, and condom use frequency. The program includes a one-day needs assessment, a half-day peer educator information session and recruitment seminar, and a two-day peer educator training. For a year or more, peer educators share HIV prevention knowledge, distribute and promote condoms, and share educator-created prevention materials with coworkers and clients during normal work routines. Peer educators meet with program staff once a week throughout the program implementation to address questions or to problem solve ways to most effectively share safer sex messages with others. The Peer Education Program was originally implemented in the Philippines among drivers in the transportation industry but can readily be adapted to .bridge. populations in other settings and industries. The program.s peer education approach may also be useful in supporting HIV prevention behaviors among peers in many different types of communities and populations. Click here to view more detailed information on this program.

Community-based Directly Observed Therapy (C-DOT) Program

Investigators: Maribel Muñoz, RN, Karen Finnegan, MPH, Jhon Zeladita, RN, Adolfo Caldas, MSW, Eduardo Sanchez, MD, Miriam Callacna, RN, Christian Rojas, MD, Jorge Arevalo, MD, Jose Luis Sebastian, MD, Cesar Bonilla, MD, Jaime Bayona, MPH, MD, & Sonya Shin, MPH, MD

The C-DOT Program aims to increase adherence of individuals living with HIV beginning highly active antiretroviral therapy (HAART). The program includes 4-day training for DOT workers. After training, DOT workers provide support to participants for a total of 11 months. For eight months DOT workers monitor all HAART doses (and doses of other medications for indications other than HIV) in participants' homes while providing social, emotional, and informational support to participants and their families and reporting missed doses, adverse events, and psychosocial crises to nurses. During the last three months DOT workers visit participants less frequently to prepare the participant for self-administration. Supervisors act as an intermediary between participants and the medical organization, coordinating other aspects of participants. medical care. Nurses supervise C-DOT Program staff and monitor follow-up care of participants. The C-DOT Program was shown to increase adherence, suppress viral load, and be associated with better tuberculosis outcomes. Additionally, the program has been shown to improve stigma, social support, self-efficacy, and health service acquisition. The C-DOT Program was originally implemented throughout the community as DOT workers conducted home visits to participants and monitored medication doses in homes or other community locations. This program may also be applicable to clinic settings and feasible to implement in clinics or hospitals serving individuals living with HIV. Click here to view more detailed information on this program.

CyberSenga

Investigators: Michelle Ybarra, Tonya Prescott, Josephine Korchmaros, Julius Kiwanuka, Sheana Bull, David Bangsberg, Norma Ware, & Ruth Birungi

CyberSenga is part of an effort to increase technology-based HIV prevention research in resource-limited settings such as Uganda. The purpose of CyberSenga is to prevent more people from getting HIV and to help those who have HIV live healthy lives by taking advantage of Internet technology to give young people both honest and truthful information, and the tools they need to make good decisions. CyberSenga consists of five one-hour modules conducted through the online CyberSenga software, along with a four-month post-intervention booster session. At the beginning of the program, participants answer two questions to sort them into four groups: abstinent boys, abstinent girls, sexually active boys, and sexually active girls. Based on their responses, participants are directed to intervention content tailored for saliency based upon their biological sex and sexual experience, although all versions include the same concepts. Content discusses relevant topics to provide youth with the information and skills they need to make healthy decisions in the future. An evaluation of CyberSenga has demonstrated that receiving the five CyberSenga sessions improves youths’ HIV preventive information as well as motivation to use condoms, and the booster session delivered four months after the initial intervention enhances the learning effect. Click here to view more detailed information on this program.

Entre Nous Jeunes

Investigators: Simon-Pierre Tegang, M.Sc., Jean Paul Tchupo, M.A., Gdon Yomi, M.Sc., & Blanche Djofang, B.A.

During the 18-month program, Entre Nous Jeunes utilizes a peer-education strategy to increase contraceptive prevalence and reduce the prevalence of STI/HIV and unintended pregnancies. Young adult peer educators in the community educate youth about HIV prevention and safer sex. Peer educators are trained during a one week-long session for the program. For two years, peer educators engage youth in the community by leading discussion groups, creating and using promotional materials, and referring peers to social and health services. The main objective of the program is for young people who have been exposed to a peer-educator to gain greater knowledge and practice more protective behaviors than those not exposed. The findings indicate the important contribution of the ENJ peer-educator program to the promotion of protective reproductive health behaviors to reduce unintended pregnancies and STIs among adolescents. In particular, the program was significantly associated with greater spontaneous knowledge of modern contraceptives and STI symptoms. Findings also suggest positive intervention effects on contraceptive knowledge for males, and virginity and contraceptive use at last intercourse for sexually active females. Click here to view more detailed information on this program.

HIV/AIDS Warriors Program

Investigators: Eric G. Bing, MD, Daniel J. Ortiz, PhD, Ricardo E. Ovalle-Bahamn, C. Phil., Karen G. Cheng, PhD, Francisco Ernesto, MD, & Cherrie B. Boyer, PhD

The HIV/AIDS Warriors Program aims to enhance HIV risk reduction knowledge, motivation, and behaviors among soldiers or other at-risk populations. The program is composed of five, 4-hour sessions delivered on consecutive days to groups of soldiers by civilian facilitators. Optional monthly booster sessions last 1-hour and reinforce the information provided by the initial program and give participants an opportunity to discuss their experiences related to the program. Program participants significantly increased their HIV/AIDS knowledge, perceived vulnerability to HIV, and condom use. Program participants also engaged in fewer unprotected sex acts with girlfriends, occasional partners, and sex workers; reduced the number of unprotected anal sex acts with live-in partners; and reduced the overall number of occasional partners and sex workers. The HIV/AIDS Warriors Program was originally designed for and implemented with soldiers in the Angolan Armed Forces. The HIV prevention messages presented in the curriculum are applicable to other non-military populations at risk of acquiring and transmitting STIs/HIV. Click here to view more detailed information on this program.

Intervention with Microfinance for AIDS and Gender Equity (IMAGE)

Investigators: Tanya Abramsky, Joanna Busza, John Gear, James Hargreaves, Julia Kim, Mzamani Benjamin Makhubele, Kalipe Mashaba, Linda Morison, Matshilo Motsei, Luceth Ndhlovu, Chris Peters, Godfrey Phetla, John Porter, Paul Pronyk, & Charlotte Watts

IMAGE is comprised of a gender and HIV training curriculum called Sisters-for-Life. A microfinance program augments the curriculum. For the microfinance component, groups of five women receive loans to establish small businesses. Further credit is offered when all women in these solidarity groups repay their loans. Loan centers of approximately 40 women meet fortnightly. Sisters-for-Life consists of two phases. Phase I is a structured series of 10 one-hour participatory training sessions that are integrated into the Loan Center meetings. Phase II moves the participants toward collective action. Natural Leaders are elected by their peers to participate in a one-week training workshop on leadership and community mobilization. Taking these skills back to their respective loan centers, these Leaders are responsible for developing an Action Plan, with the aim of implementing what they regard as appropriate responses to priority issues. Click here to view more detailed information on this program.

Mujer Segura, Healthy Woman

Investigators: Thomas Patterson, Brent Mausbach, Remedios Lozada, Hugo Staines-Orozco, Shirley Semple, Miguel Fraga-Vallejo, Prisci Orozovich, Daniela Abramovitz, Adela de la Torre, Hortensia Amaro, Gustavo Martinez, Carlos Magis-Rodriguez, & Steffanie Strathdee

The Mujer Segura Program aims to increase female sex workers' use of condoms during all sex exchanges. The program demonstrated increases in the total number of protected sex acts and decreases in overall sexually transmitted infection (including HIV) incidence. The program is composed of one session, lasting approximately 35 minutes. During this session, the counselor meets one-on-one with the individual participant and through the use of Motivational Interviewing techniques, assesses sexual risk behaviors; increases awareness of challenges related to condom use; and helps the participant develop solutions to increase safer sex practices. The counselor distributes free condoms and lubricant to all participants. Supervisors meet weekly with the program counselors to discuss program implementation and address any issues that may The Mujer Segura Program was originally implemented in two Mexican border cities of the United States with female sex workers. Although this program was specifically designed to increase condom use during sex exchanges, it may be suitable for use with other at-risk groups who engage in risky sexual behaviors. Click here to view more detailed information on this program.

Voluntary Counseling and Testing for Female Sex Workers (VCT Program)

Investigators: Xiaoming Li, PhD, Bo Wang, PhD, Xiaoyi Fang, PhD, Ran Zhao, MD, Bonita Stanton,MD, Yan Hong, MA, Baiqing Dong, MD, Wei Liu, MD, Yuejiao Zhou, MD, Shaoling Liang, MD, & Hongmei Yang, PhD

The VCT Program aims to increase STI/HIV testing, awareness of infection, STI/HIV knowledge, and consistent use of condoms among female sex workers in China in order to ultimately reduce rates of STI infections. The VCT Program demonstrated increases in knowledge of STI/HIV knowledge and consistent condom use, and decreases in STI incidence. The VCT Program is composed of a pre-test counseling session, STI/HIV testing, and a post-test counseling session. During the first 25-minute VCT counseling session, the counselor works with the participant to: complete a risk assessment; identify challenges related to risk reduction; create a risk reduction plan; and practice condom use skills. After the first counseling session, the participant completes STI/HIV testing. During the 20-minute post-test counseling session, the counselor shares test results and reviews treatment options and risk reduction plans. The VCT Program was originally implemented in a suburban area of Nanning in southern China with female sex workers recruited from entertainment establishments. This program's voluntary counseling and testing content and approach may be useful in increasing testing and safer sex behaviors in many different types of communities and populations. Click here to view more detailed information on this program.

mDOT Program: For Individuals Receiving Highly Active Antiretroviral Therapy (HAART)

Investigators: Cynthia R. Pearson, PhD, Mark Micek, MD, Jane M. Simoni, PhD, Eduardo Matediana, MD, Diane P. Martin, PhD, & Stephen Gloyd, MD, MPH

The mDOT Program aims to increase adherence to highly active antiretroviral therapy (HAART) for individuals living with HIV/AIDS through peer-provided directly observed therapy. The program significantly increased adherence to HAART at 6-week, 6-month, and 1-year follow ups and significantly increased the number of program participants achieving more than 90% adherence after 6 months. Peer educators are trained during a 2-day workshop to deliver directly observed therapy and support HAART adherence. After training, peer educators monitor morning HAART doses during the 6-week program period. Peer educators provide social support, adherence advice and health information to participants throughout the program. Peer educators complete refresher training every three months throughout the program. The mDOT Program was originally implemented in Beira, Mozambique, at a large-volume public institution providing free specialized HIV care and antiretroviral medications. Although this program was designed to operate in an HIV clinic or hospital, it may be feasible for other community-based organizations serving individuals living with HIV to implement the mDOT program. Click here to view more detailed information on this program.