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Thetha Nami : participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Thetha Nami : participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa
Thetha Nami : participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Background: Despite 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). Methods: Between 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). Results: Following 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. Conclusion: Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

Adolescents, Community-based participatory research, HIV, Health promotion, Peer-led, Pre-exposure prophylaxis, Sexual health, Social capital, South Africa, Young people
1471-2458
Shahmanesh, Maryam
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Okesola, Nonhlanhla
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Chimbindi, Natsayi
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Zuma, Thembelihle
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Mthiyane, Nondumiso
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Adeagbo, Oluwafemi
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Dreyer, Jaco
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Herbst, Carina
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Mdluli, Sakhile
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Mcgrath, Nuala
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Harling, Guy
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Sherr, Lorraine
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Seeley, Janet
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Shahmanesh, Maryam
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Okesola, Nonhlanhla
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Chimbindi, Natsayi
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Zuma, Thembelihle
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Mthiyane, Nondumiso
e47691b1-0dcc-4699-b77b-e3b13748fa77
Adeagbo, Oluwafemi
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Dreyer, Jaco
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Herbst, Carina
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Mdluli, Sakhile
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Mcgrath, Nuala
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Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Sherr, Lorraine
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Seeley, Janet
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Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, Mdluli, Sakhile, Mcgrath, Nuala, Harling, Guy, Sherr, Lorraine and Seeley, Janet (2021) Thetha Nami : participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa. BMC Public Health, 21 (1), [1393]. (doi:10.1186/s12889-021-11399-z).

Record type: Article

Abstract

Background: Despite 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). Methods: Between 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). Results: Following 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. Conclusion: Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

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Accepted/In Press date: 13 May 2021
Published date: 13 July 2021
Additional Information: Funding Information: This work was supported by the National Institutes of Health under award number 5R01MH114560–03, Bill & Melinda Gates Foundation, Grant Number OPP1136774 and OPP1171600. Africa Health Research Institute is supported by a grant from the Wellcome Trust (082384/Z/07/Z). The AHRI population surveillance is partially funded by DSI-MRC South Africa Population Research Network. GH is supported by a fellowship from the Wellcome Trust and Royal Society (210479/Z/18/Z). NM2 is a recipient of an NIHR Research Professorship award (Ref: RP-2017-08-ST2–008). Funding bodies were not involved in the design of the study, data collection, analysis or interpretation of the data. Funding Information: The authors acknowledge AHRI research team including the research assistants (B. Mbatha, D. Mkhwanazi, K. Ngobese, N. Buthelezi, N. Fakude, N. Mbatha, S. Nsiband, S. Ntshangase, S. Mnyango, Th. Dlamini, Z. Cumbane, Z. Mathenjwa, M. Zikhali, N. Mpanza, S. Xulu, X. Ngwenya, Zakhele Xulu, Z. Mthethwa, S. Hlongwane), the Thetha Nami peer navigators, (A. Koza, B. Sangweni, B. Mthabela, B. Kunene. H.D. Ncanana, H. Mpanza, L. Ncube, M. Mthethwa, M. Mtshali, M. Manqele, M. Mkhwanazi, N. Zuma, N. Mkhwanazi, N. Zulu, N. Mncube, N. Mkhwanazi, N. Dube, N. Mkhwanazi, N. Mtshali, N. Ndlovu, N. Mncwango, N. Hlabisa, N. Mthethw, N. Mashaya, N. Mantengu, N. Mpanza, N. Nyawo, N. Mkhasibe, N. Kunene, N. Khumalo, N. Masuku, S. Zungu, S. Mhlongo, S. Mbuyazi, S. Mlungwana, S. Mngomezulu, S. Nkosi, S. Sangweni, S. Thethwayo, S. Sithole, S. Mbatha, S. Ngwenya, S. Masango, Th. Mkhwanazi, Th. Mthembu, Th. Manqele, Th. Vilane, T. Madini, X. Ncube, Z. Gumede, Z. Khumalo, Z. Thabethe) clinical team (B.S. Luthuli, F. Shange, Hl. Ncanana, L. Mlambo, N. Vilane, N. Ntombela, N. Ngcobo, S. Majozi, S. Msane, Z. Myeni, S. Mdluli) and research administrators, especially A. Jalazi and S. Mbili, for their commitment to the study. We also extend our appreciation to our research community including the community advisory boards in uMkhanyakude district. We thank the peer reviewers from BMC public health who helped strengthen this paper considerably. Publisher Copyright: © 2021, The Author(s).
Keywords: Adolescents, Community-based participatory research, HIV, Health promotion, Peer-led, Pre-exposure prophylaxis, Sexual health, Social capital, South Africa, Young people

Identifiers

Local EPrints ID: 449244
URI: http://eprints.soton.ac.uk/id/eprint/449244
ISSN: 1471-2458
PURE UUID: 7d6b9384-dd6e-4d77-b71a-750cac2cbe52
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 20 May 2021 16:32
Last modified: 17 Mar 2024 03:32

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Contributors

Author: Maryam Shahmanesh
Author: Nonhlanhla Okesola
Author: Natsayi Chimbindi
Author: Thembelihle Zuma
Author: Nondumiso Mthiyane
Author: Oluwafemi Adeagbo
Author: Jaco Dreyer
Author: Carina Herbst
Author: Sakhile Mdluli
Author: Nuala Mcgrath ORCID iD
Author: Guy Harling
Author: Lorraine Sherr
Author: Janet Seeley

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