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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. We used community-based participatory research (CBPR) informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in rural 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 accessible 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 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; 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
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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, 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. We used community-based participatory research (CBPR) informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in rural 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 accessible 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 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; 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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Theta_Nami_revision_Dec2020 - Accepted Manuscript
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Accepted/In Press date: 13 May 2021
Published date: 13 July 2021
Additional Information: Funding 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.
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

Catalogue record

Date deposited: 20 May 2021 16:32
Last modified: 26 Nov 2021 03:00

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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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