Health diplomacy and the adaptation of global health interventions to local needs in sub-Saharan Africa and Thailand: Evaluating findings from Project Accept (HPTN 043)

BMC Public Health

Stephen F Morin⁸  Katherine Fritz⁹  Kathryn Curran^1,10  Marta Mulawa⁴  Elizabeth Paradza⁷  Chonlisa Chariyalertsak⁷  Suwat Chariyalertsak³  Surinda Kawichai³  Jessie Mbwambo¹  Khalifa Mrumbi¹  Heidi Van Rooyen²  Glenda Gray²  Precious Modiba⁶  Alfred Chingono⁷  Oliver Murima⁷  Gertrude Khumalo-Sakutukwa⁸  Sebastian Kevany⁵ 

[1] Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Human Sciences Research Council, Durban, South Africa;Chiang Mai University, Chiang Mai, Thailand;Medical University of South Carolina, Charleston, USA;Center for AIDS Prevention Studies, University of California, San Francisco, USA;Perinatal Health Research Unit, Soweto, South Africa;University of Zimbabwe, Harare, Zimbabwe;Institute for Health Policy Studies, University of California, San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA;International Center for Research on Women, Washington, DC;Department of Epidemiology, University of Washington, Seattle, WA, USA

关键词: Sub-Saharan Africa;    HIV;    Global health diplomacy;    Voluntary counseling and testing;    Adaptations;   

Others  :  1163516
DOI  :  10.1186/1471-2458-12-459

 received in 2011-08-26, accepted in 2012-03-19,  发布年份 2012

【 摘 要 】

Background

Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of ‘global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention.

Methods

We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation.

Results

Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of ‘youth-friendly’ services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites).

Conclusions

Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective.

【 授权许可】

   
2012 Kevany et al.; licensee BioMed Central Ltd.

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