lying factors that hindered at-risk women from joining VOICE. Methods: Women aged 18â45 ... sensitized about the VOICE study. Prospective ... Southern Africa.
significant drop in HIV-1 incidence. The VOICE study evaluated safety and effectiveness of daily use of female-controlled ARVbased oral and topical vaginal HIV prophylaxis. Despite being at risk of HIV-1 acquisition, and having limited prevention tools, many women declined to join the study. We describe the underlying factors that hindered at-risk women from joining VOICE. Methods: Women aged 18–45 in high-risk communities identified by the Uganda HIV/AIDS sero-Behavioral Survey 2004–05 were sensitized about the VOICE study. Prospective participants’ questions and concerns were addressed, and those willing to be screened on site were systematically pre-screened using an IRB-approved checklist with multiple risk questions. Presumptively eligible women were given appointments and reminded by telephone calls. Results: From November 2009 to December 2011, among the 3,217 women sensitized in the community, only 25% (n = 820) were interested and pre-screened. Of those expected to turn up, only 43% (n = 356) showed for appointments. Among those who did not turn up (n = 464), 78% (n = 362) did not know or were not sure of their partners HIV status and feared finding out their HIV status; 58% (n = 269) were not living with their partner(s) and could not choose from which partner to obtain permission; and 30% (n = 139) had no income and feared losing financial support from their partners. Other factors included fear of side effects, myths and misconceptions about clinical research. Others needed more time to think about participation, and the rest promised to come for screening but later changed their minds. Conclusions: Women are challenged by the fear of knowing their HIV status, exacerbated by lack of independence to make decisions about study participation. There is more need to sensitize communities about HIV prevention research, participant challenges and involving male partners in research.
OA09.02 Community Engagement in a Volatile Community Post-marikana for a Phase III Microbicide Ring Trial Cheryl Emily Louw1, Ntswaki Rose Masilo1, Marthie de Villiers1, Annalene M. Nel2, Michelle Isaacs2 1
Madibeng Centre for Research, Brits, South Africa, 2International Partnership for Microbicides, Paarl, South Africa Background: When Madibeng Centre for Research (MCR) began its work on a Vaginal Microbicide Ring Phase III trial the surrounding community was peaceful. Wage negotiations in the surrounding mines became tense leading up to the Marikana massacre on 16 August 2012, just more than 4 months into the trial. The situation in the area remained tense and also led to male partner aggression towards their female partners. Partners viewed the trial and the ring with suspicion resulting in some participants being forced to stop using the ring and to withdraw from the trial. Methods: With participant consent, MCR strategized on ways to reach out to the affected participants’ partners and to engage the local community: Partners were visited personally and given appropriate information on the trial Partners were invited to attend the research centre (RC) to view procedures and interview the Principal Investigator Upscaled community engagement and education occurred in the communities close to Marikana Participants were educated and equipped to deal with partners who did not wish them to use the ring, or who wanted them to withdraw against their will
Results: Partners who accepted a visit from the Community Liaison Officer were in favour of the trial and their female partners’ participation on the trial. Some partners visited the RC to observe all procedures before accepting that their female partners could continue on the trial. Women felt more equipped to deal with partner objections to the trial. Early trial withdrawal for partner related issues decreased substantially after the intervention. Conclusions: The situation around a research centre could change dramatically overnight. Unrelated incidents could have a ripple effect on the clinical trials in the area. Partners may transfer their frustration and anger onto their female partners, affecting their compliance to the protocol. With appropriate intervention using a multi-pronged approach it is possible to turn such a situation around.
OA09.03 Employing a Youth-centered Approach to Investigate HIV Risk among Adolescents and Young Adults in an HIV Hyper-endemic Setting Janan Dietrich1, Laura Cotton2, Stefanie Hornschuh1, Martin van der Watt1, Cari L. Miller2, Glenda Gray1, Mark Brockman2, Angela Kaida2, on behalf of the AYAZAZI Study Team 1 Perinatal HIV Research Unit, Soweto, South Africa, 2Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
Background: Adolescents and young adults (AYA) (10–24 years) are significantly at risk of HIV acquisition across Southern Africa. The continued burden of HIV transmission among AYA reflects poor prioritization of youth-focused and engaged research yielding an inadequate understanding of intersecting factors necessary to implement accessible and effective HIV prevention programs. Use of youth-centered approaches within HIV research and programming presents a critical opportunity to engage youth, build capacity, and support youth leadership in the HIV response. Methods: AYAZAZI (‘Knowing Themselves’ in Zulu) is a youth-centered, inter-disciplinary cohort study that aims to link socio-behavioural, structural, clinical, and biomedical data to understand HIV acquisition risk among AYA aged 16–24 years living in Soweto, South Africa. We aim to enroll a cohort of 400 AYA (HIV-negative or HIV status unknown) followed biannually for three years. Results: AYAZAZI uses a youth-centered approach to engage AYA throughout the research process. A Soweto-based Adolescent Community Advisory Board provides overall study guidance and oversight. We engaged the expertise and lived experiences of community members in the development of the survey and clinical protocol to ensure youth-appropriate language and priorities. AYA research assistants from Soweto were hired and trained to support recruitment and to administer surveys. We engaged with several youth-focused community partners to conduct outreach and raise awareness of AYAZAZI. AYA research assistants will receive ongoing training to support skill development and participants will have access to regular knowledge exchange forums to support youth leadership around HIV knowledge in the community. Conclusions: Youth-centered, inter-disciplinary approaches that engage young people throughout the research process are critical to support, empower, and build local capacity required to prevent HIV infection and reverse the high HIV risk environment among youth in South Africa.
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