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HIV-   HIV+   CD4<350   VL<50 CD4>250
Prevention…

Primary prevention: prevention of diseases
and conditions before biological onset
Secondary prevention: the identification and
interdiction of diseases that are present in
the body, but that have not progressed to
the point of causing signs, symptoms, and
dysfunction
Tertiary prevention: the prevention of
disease progression and suffering after it is
clinically obvious. It prevents morbidity and
mortality
Retention through Motivation
                     Definition adapted from: Robert B Wallace, The Gale Group Inc
VCT+ …

VCT(+):
Confidential HIV screening, CD4 staging, TB
questionnaire, referral
 VCT+ is not an outcome
 VCT+ entry point into a continuum of care
 100% uptake of target group
 Annual VCT+
 Prevalence & incidence
Retention Strategies Applied in the Community


Intensive adherence management
Childcare program
Sports program
Drama and music
Theatre “The Miracle”
Entrepreneurship
Retention through motivation
CHAMP Prevention program




•Community participation
•Family involvement
•Integrated into Social Mobilisation
•Integrated into Primary Healthcare
Outcome measures of success…


Primary prevention: reduced Prevalence &
Incidence (VCT+, CD4, stigma)
Secondary prevention: earlier care seeking
behaviour (VCT+, CD4, stigma)
Tertiary prevention: lowered morbidity &
mortality
Retention for life – motivation &
destigmatisation
Some early results…
Mean Baselines




                       400    300
             mean of cd4count
                  200  100
                       0




                                        0            1

Mean baseline cd4 count at clinic (0=NMC, mean baseline cd4 count=189.5
cells/ul) and Outreach patients (1= Outreach patients, mean baseline cd4
counts= 341.7cells/ul)
What has gone wrong with past strategies

• Atheoretical not informed by behavioural science
  models
• Target groups not assessed, messages not tailored
  to target population,
• Messaging too broad with a general focus
• Information without practical advice
• Fail to motivate, do not teach behavioural skills
• Not rigorously evaluated
• Not disseminated widely
                   Fisher, JD SA AIDS conference 2009. Changing AIDS-
                   Risk behaviour
mean of age
    0   10      20         30   40




0
                                     Mean Ages




1
Sex distribution


                   0                            1




                        Female   1   Male   2
Graphs by time
Thank you
Questions & Discussion

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05 Slabbert Sahara Conference M Slabbert 2

  • 1.
  • 2.
  • 3. HIV- HIV+ CD4<350 VL<50 CD4>250
  • 4. Prevention… Primary prevention: prevention of diseases and conditions before biological onset Secondary prevention: the identification and interdiction of diseases that are present in the body, but that have not progressed to the point of causing signs, symptoms, and dysfunction Tertiary prevention: the prevention of disease progression and suffering after it is clinically obvious. It prevents morbidity and mortality Retention through Motivation Definition adapted from: Robert B Wallace, The Gale Group Inc
  • 5.
  • 6. VCT+ … VCT(+): Confidential HIV screening, CD4 staging, TB questionnaire, referral VCT+ is not an outcome VCT+ entry point into a continuum of care 100% uptake of target group Annual VCT+ Prevalence & incidence
  • 7.
  • 8. Retention Strategies Applied in the Community Intensive adherence management Childcare program Sports program Drama and music Theatre “The Miracle” Entrepreneurship Retention through motivation
  • 9. CHAMP Prevention program •Community participation •Family involvement •Integrated into Social Mobilisation •Integrated into Primary Healthcare
  • 10. Outcome measures of success… Primary prevention: reduced Prevalence & Incidence (VCT+, CD4, stigma) Secondary prevention: earlier care seeking behaviour (VCT+, CD4, stigma) Tertiary prevention: lowered morbidity & mortality Retention for life – motivation & destigmatisation
  • 12. Mean Baselines 400 300 mean of cd4count 200 100 0 0 1 Mean baseline cd4 count at clinic (0=NMC, mean baseline cd4 count=189.5 cells/ul) and Outreach patients (1= Outreach patients, mean baseline cd4 counts= 341.7cells/ul)
  • 13.
  • 14. What has gone wrong with past strategies • Atheoretical not informed by behavioural science models • Target groups not assessed, messages not tailored to target population, • Messaging too broad with a general focus • Information without practical advice • Fail to motivate, do not teach behavioural skills • Not rigorously evaluated • Not disseminated widely Fisher, JD SA AIDS conference 2009. Changing AIDS- Risk behaviour
  • 15.
  • 16. mean of age 0 10 20 30 40 0 Mean Ages 1
  • 17. Sex distribution 0 1 Female 1 Male 2 Graphs by time
  • 18. Thank you Questions & Discussion