effect of a values-based prevention curriculum on hiv- positive couples from four regions in...
TRANSCRIPT
Effect of a values-based prevention curriculum on HIV-
positive couples from four regions in Ethiopia
Presented at XIX IAC 2012By Misgina Suba, MPH
25 July 2012
Background
• Evidence increasingly reveals that much of the heterosexual HIV transmission in Southern and East Africa takes place within marriage or cohabitation.
• The Faithful House (TFH) is a culturally sensitive skills-building HIV prevention program designed to strengthen relationships for cohabitating couples .
Program Description
• TFH is a 5-day participatory curriculum developed by CRS and Maternal Life International
• Groups of 10-15 couples complete sessions together and as couples
• Facilitators guide discussion by the interest and needs of the group
Program Description
• Drama, role plays and pictures evoke discussion so literacy is not required
• Modified for couples living with HIV and PMTCT programs
• CRS has trained facilitators in 12 countries and reached over 79,000 beneficiaries
•
Study Objective
Assess the outcomes of TFH for PLHIV on:
• Couples’ communication, quality of relationship• Family strengthening attitudes and behaviors
• Couples’ health maintenance behaviors, such as adherence to medication, health visit completion and follow-up
Methodology
• Study design: Quantitative and qualitative methods, randomized controlled trial
• Study period: June 1 to Sept 30, 2011• Sample size : 204 couples living with HIV• Data collection : standardized survey by trained
enumerator• Comparison: intervention and control at 3
month follow-up
Results: Demographic
• 10% of couples were HIV discordant
• 99% urban population
• 45% cohabiting; 43% traditional marriage
• 87% had children; 35% caring for OVC
• 46% of males; 68% of females did not complete primary education
Results: Relationship Satisfaction
Indicator (Scale 1-10)
Control Group Intervention Group
Baseline 3-Mo. Baseline 3-Mo.
Relationship quality 7.3 8.0** 7.3 8.6**Communication quality 7.3 8.1** 7.5 8.7**Respect received from partner 7.5 8.3** 8.0 9.0**
Sharing personal income and financial assets 7.4 8.1* 7.5 9.0**Have an open discussion with partner about sex 7.5 7.2 7.9 8.4*
* = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)
Results: Family Indicators
Indicator
Control Intervention
Baseline 3-Mo. Baseline 3-Mo.
Both partners responsible for caring for children 57% 51% 60% 70%*
Joint decision-making power on important family matters 55% 63% 53% 71%*
Joint decision-making power on when to have sex 37% 56%* 43% 71%**
Participants writing Will in past 3 months 13% 58%**
* = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)
Results: Health Status
IndicatorsControl Intervention
Baseline 3-Mo. Baseline 3-Mo.
% non-adherent to their regimen^
18% 16% 18% 10%*
% diagnosed with a STI in the last 3 months
8.7% 9.3% 7.3% 4.7%
% male partners initiated new care-taking in past 3 months 26% 79%*
Joint decision-making power on accessing HIV services 65% 71% 67% 75%
*= statistically significant change (p<0.05)^ non adherent defined by three or more missed doses in the last month
Results: Partner Violence
Family Life Control Intervention
Indicator Baseline 3-Mo. Baseline 3-Mo.% all forms violence or
threat 46% 39% 47% 31%
% physical violence14% 10% 17% 6%
Qualitative Results
The primary findings from our focus group discussions:
1. TFH helped couples reconcile after disclosure and blame related to the positive diagnosis.
2. TFH provided couples with the skills needed for conflict resolution.
Participants in TFH workshop going together for VCT
10 – Month Follow-Up
Question (Response scale 1-10) Intervention Control
Overall quality of communication 8.92 8.11**
Discuss financial issues 8.96 8.34*
Discuss sexual issues 8.46 7.15**
Sexual satisfaction with partner 8.45 7.71**
Overall quality of the relationship 8.95 8.02**
Partner has knowledge , values and skills to be faithful
8.99 8.33**
* = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)
Gender
Survey Question , scale 1-10 Intervention Female Male P-valueOverall quality of communication
8.92 8.84 9.01 0.45
Discuss on financial issues 8.96 8.87 9.07 0.38Discuss on sexual issues 8.46 8.46 8.47 0.97Sexual satisfaction with partner
8.45 8.45 8.46 0.96
Overall quality of relationship
8.95 8.76 9.15 0.09
Partner has knowledge, values and skills to be faithful
8.99 8.87 9.13 0.36
Study Limitations
• Surveys not translated into all the local languages.
• No objective data to validate self reported responses
• All couple participants were self-selecting, already enrolled in HIV treatment and care services, and only eligible if both partners could attend
• Attention bias
Conclusion
• TFH has a positive impact on attitudes and determinants of behaviors that affect relationship and physical health.
• TFH can be used to encourage male involvement in care of sick children and couple participation in PMTCT and ART programs.
• TFH is being evaluated to test its potential use in encouraging female participation in decision making around use of household assets.
