“Challenge of evaluating a national HIV prevention program: The case of loveLife, South Africa,”

Department of Epidemiology, CB #7435, McGavran-Greenberg Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
Sexually Transmitted Infections (Impact Factor: 3.4). 09/2007; 83 Suppl 1(Suppl 1):i70-74. DOI: 10.1136/sti.2006.023689
Source: PubMed


Although 50% of all new global HIV infections occur among young people, our knowledge to date of the impact of adolescent HIV prevention interventions in developing country settings is limited. During 1999, a national HIV prevention programme for youth, called loveLife, was launched in South Africa. This paper describes the challenges faced in trying to evaluate such a national programme and the types of evidence that could be used to better understand the effect of programmes of national scale. A range of methods were planned to evaluate the programme, including national household surveys and programme monitoring data. Given the urgent need to scale-up programmes in an effort to reduce new HIV infections, a range of evidence should be assessed to measure the effect of large-scale, complex behavioural interventions as an alternative to randomised controlled trials.

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    • "Between 1999 and 2006 loveLife managed this programme under the name of the National Adolescent Friendly Clinic Initiative (NAFCI) as one component of a national HIV prevention campaign which combined a sustained, multi-media HIV awareness and education campaign with outreach services including youth centres (Y-Centres) and peer educators (known as groundBREAKERS) [35]. NAFCI involved training service providers, efforts to improve facilities, multi-media campaigns and activities in the community and with other sectors [36]. A set of “adolescent-friendly” standards that included those relating to the types of services provided, policies supporting adolescents’ rights to healthcare and the clinic environment were defined for clinics to work towards using a facilitated approach [37]. "
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    ABSTRACT: Background Youth-friendly health services are a key strategy for improving young people’s health. This is the first study investigating provision of the Youth Friendly Services programme in South Africa since the national Department of Health took over its management in 2006. In a rural area of South Africa, we aimed to describe the characteristics of the publicly-funded primary healthcare facilities, investigate the proportion of facilities that provided the Youth Friendly Services programme and examine healthcare workers’ perceived barriers to and facilitators of the provision of youth-friendly health services. Methods Semi-structured interviews were conducted with nurses of all eight publicly-funded primary healthcare facilities in Agincourt sub-district, Mpumalanga Province, South Africa. Thematic analysis of interview transcripts was conducted and data saturation was reached. Results Participants largely felt that the Youth Friendly Services programme was not implemented in their primary healthcare facilities, with the exception of one clinic. Barriers to provision reported by nurses were: lack of youth-friendly training among staff and lack of a dedicated space for young people. Four of the eight facilities did not appear to uphold the right of young people aged 12 years and older to access healthcare independently. Breaches in young people’s confidentiality to parents were reported. Conclusions Participants reported that provision of the Youth Friendly Services programme is limited in this sub-district, and below the Department of Health’s target that 70% of primary healthcare facilities should provide these services. Whilst a dedicated space for young people is unlikely to be feasible or necessary, all facilities have the potential to be youth-friendly in terms of staff attitudes and actions. Training and on-going support should be provided to facilitate this; the importance of such training is emphasised by staff. More than one member of staff per facility should be trained to allow for staff turnover. As one of a few countrywide, government-run youth-friendly clinic programmes in a low or middle-income country, these results may be of interest to programme managers and policy makers in such settings.
    BMC Health Services Research 06/2014; 14(1):259. DOI:10.1186/1472-6963-14-259 · 1.71 Impact Factor
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    • "The results further confirm loveLife's emphasis on normative and social factors as being one of the issues that young people have to contend with in their constructions of sexuality, and this seems to be particularly true of young women [22, 23]. For instance, more young women report having had sex with a much older partner. "
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    ABSTRACT: Even though a decline in HIV prevalence has been reported among South African youth 15-24 from 10.3% in 2005 to 8.6% in 2008, the prevalence remains disproportionately high for females overall in comparison to males. This study examines factors associated by HIV risk reduction self-efficacy of South African youth as part of an evaluation of the impact of loveLife, a youth focused HIV prevention programme. A cross-sectional population-based household survey was conducted with persons of ages 18 to 24 years in four selected provinces in South Africa. Among female respondents (n = 1007), factors associated with high self-efficacy in the adjusted model were having a low HIV risk perception, HIV/AIDS stigma, ever using drugs, and having life goals. Male respondents (n = 1127) with high self-efficacy were more likely to have been tested for HIV, have concurrent sexual partners, have had a transactional sex partner in lifetime, a low HIV risk perception, difficulty in having condoms, agreed with coercive sex, high relationship control, and had loveLife face-to-face programme participation. The factors identified with high self-efficacy and HIV-sexual risk behaviour may be considered to strengthen youth HIV prevention programmes in South Africa.
    The Scientific World Journal 11/2012; 2012(14):817315. DOI:10.1100/2012/817315 · 1.73 Impact Factor
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    • "In an evaluation of a youth programme (loveLife) (combining multimedia and community outreach and support programmes) in South Africa, Pettifor et al. [11] found that the participation in loveLife reduced chances of being infected with HIV, and youth were more likely to report condom use at last sex and used condoms more consistently. "
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    ABSTRACT: In South Africa social and behavioural communication interventions are a critical component of HIV/AIDS prevention, and numerous communication campaigns have been implemented intensively across the country through government initiatives and nongovernmental organisations over the past decade. The aim of this paper is to assess the reach of HIV and AIDS communication campaigns in conjunction with contributions to knowledge, attitudes, and HIV risk behaviours in the general population in South Africa. The sample included in this nationally representative cross-sectional survey was 13234 people aged 15-55 years. Overall, the study found that there was high exposure to 18 different HIV communication programmes (median 6 programmes and 14 programmes more than 30%) across different age groups. Most programmes were more often seen or heard by young people aged between 15 and 24 years. In multivariate analysis, greater exposure to HIV mass communication programmes was associated with greater HIV knowledge, condom use at last sex, having tested for HIV in the past 12 months, and less stigmatizing attitude toward PLWHA.
    The Scientific World Journal 11/2012; 2012(8):384608. DOI:10.1100/2012/384608 · 1.73 Impact Factor
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