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01-10-2021 | Human Immunodeficiency Virus

Barriers and Facilitators to Effective Implementation of the NAMWEZA Intervention in Dar es Salaam, Tanzania

Authors: Magreat Somba, Sylvia Kaaya, Hellen Siril, Kicki Oljemark, Donald Ainebyona, Elspeth McAdam, James Todd, Irene Andrew, Keith McAdam, Alice Simwinga, Neema Mleli, Samwel Makongwa, Sabina Haberlen, Mary C. Smith Fawzi

Published in: Prevention Science | Issue 7/2021

Abstract

The NAMWEZA intervention was implemented, using a ten-session group format, to build skills targeting psychosocial vulnerabilities and enhancing HIV prevention among people living with HIV (PLH) and their social networks. The overall goal of this intervention is to improve psychological wellbeing and reduce HIV risk behaviours. These analyses aim to describe the barriers and facilitators of implementing the NAMWEZA intervention from the perspective of participants and trained peer group facilitators. Twenty-four in-depth interviews were conducted with NAMWEZA participants, and 50 pooled peer facilitator self-assessment reports were obtained from 16 trained peers. Participants identified personal and structural barriers, including fear of inadvertent HIV status disclosure, time constraints, level of participant reimbursements, and limited space available for group sessions. Factors facilitating effective implementation included perceived benefits of the program, such as reduction in HIV-related risk behaviours, increased self-esteem, and improvement in confidence in HIV prevention communications. Scaling up the NAMWEZA intervention to other areas of Tanzania or regionally should take into account these facilitators and barriers to implementation.

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Albritton, T., Hodge-Sallah, S., Akers, A., Blumenthal, C., O’Brien, S., Council, B., & Corbie-Smith, G. (2014). A process evaluation of an HIV/STI intervention for rural African American youth. Qualitative Health Research, 24, 969–982. https://doi.org/10.1177/1049732314540053CrossRefPubMedPubMedCentral

Avert. (2018). Global information and education on HIV and AIDS HIV and AIDS in Tanzania Retrieved 13–07, 2020, from https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/tanzania

Carter, C. A., Ruhe, M. C., Weyer, S., Litaker, D., Fry, R. E., & Stange, K. C. (2007). An appreciative inquiry approach to practice improvement and transformative change in health care settings. [Research Support, N.I.H., Extramural]. Quality Management in Healthcare, 16, 194–204. https://doi.org/10.1097/01.QMH.0000281055.15177.79

Chitalu, N., Mumbi, M., Cook, R., Weiss, S. M., & Jones, D. (2016). The impact of key HIV intervention components as predictors of sexual barrier use: The Zambia Partner Project. [Research Support, N.I.H., Extramural]. Journal of the International Association of Providers of AIDS Care (JIAPAC), 15, 51–58. https://doi.org/10.1177/2325957414520980

Chun Tie, Y., Birks, M., & Francis, K. (2019). Grounded theory research: A design framework for novice researchers. SAGE Open Med, 7, 2050312118822927. https://doi.org/10.1177/2050312118822927CrossRefPubMedPubMedCentral

Creswell JW, C. J. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. (4 ed.): SAGE Publications.

Dwyer-Lindgren, L., Cork, M. A., Sligar, A., Steuben, K. M., Wilson, K. F., Provost, N. R., & Hay, S. I. (2019). Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. Nature, 570, 189–193. https://doi.org/10.1038/s41586-019-1200-9

Evans, C., Turner, K., Suggs, L. S., Occa, A., Juma, A., & Blake, H. (2016). Developing a mHealth intervention to promote uptake of HIV testing among African communities in the UK: a qualitative study. BMC Public Health, 16, 656. https://doi.org/10.1186/s12889-016-3278-4CrossRefPubMedPubMedCentral

Gurol-Urganci, I., de Jongh, T., Vodopivec-Jamsek, V., Atun, R., & Car, J. (2013). Mobile phone messaging reminders for attendance at healthcare appointments. [Meta-analysis review systematic review]. Cochrane Database Syst Rev, CD007458. https://doi.org/10.1002/14651858.CD007458.pub3

Hadjipateras A, A. H., & Owero J. (2006). Joining Hands Integrating Gender and HIV/AIDS: Report of an ACORD Project using Stepping Stones in Angola, Tanzania and Uganda.

Hall, B. J., Sou, K. L., Beanland, R., Lacky, M., Tso, L. S., Ma, Q., & Tucker, J. D. (2017). Barriers and facilitators to interventions improving retention in HIV care: A qualitative evidence meta-synthesis. [Meta-Analysis]. AIDS Behav, 21, 1755–1767. https://doi.org/10.1007/s10461-016-1537-0

Holden, S., Gordon, G. D. V., Chiziza, G.,Kiwia, N., Magesa, P., Manyama D., & Welbourn, W., A. (2019). Building resilience to adverse childhood experiences: An assessment of the effects of the Stepping Stones with Children training programme on Tanzanian children affected by HIV and their caregivers. Health Education Journal, 78, 124–137. https://doi.org/10.1177/0017896918787217

Jewkes, R., Nduna, M., Levin, J., Jama, N., Dunkle, K., Puren, A., & Duvvury, N. (2008). Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: Cluster randomised controlled trial. [Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. BMJ, 337, a506. https://doi.org/10.1136/bmj.a506

Jones, D., Weiss, S., & Chitalu, N. (2015). HIV prevention in resource limited settings: A case study of challenges and opportunities for implementation. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. International Journal of Behavioral Medicine, 22, 384–392. https://doi.org/10.1007/s12529-014-9397-3

Kharsany, A. B., & Karim, Q. A. (2016). HIV infection and AIDS in Sub-Saharan Africa: Current status, challenges and opportunities. The Open AIDS Journal, 10, 34–48. https://doi.org/10.2174/1874613601610010034.CrossRefPubMedPubMedCentral

McAdam E, W. A., Steinberg C, et al (2011). NAMWEZA friends intervention programme, Namweza Center. United Kingdom and Sweden Retrieved 07–02, 2020, from http://www.namweza.org/?page_id=367

McCreary, L. L., Kaponda, C. P., Kafulafula, U. K., Ngalande, R. C., Kumbani, L. C., Jere, D. L., . . . Norr, K. F. (2010). Process evaluation of HIV prevention peer groups in Malawi: A look inside the black box. [Evaluation Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. Health Educ Research, 25, 965–978. https://doi.org/10.1093/her/cyq049

Mngadi, K. T., Frohlich, J., Montague, C., Singh, J., Nkomonde, N., Mvandaba, N., & Mansoor, L. (2015). Challenges with participant reimbursement: experiences from a post-trial access study. Journal of Medical Ethics, 41, 909–913. https://doi.org/10.1136/medethics-2013-101899CrossRefPubMed

Mundell, J. P., Visser, M. J., Makin, J. D., Kershaw, T. S., Forsyth, B. W., Jeffery, B., & Sikkema, K. J. (2011). The impact of structured support groups for pregnant South African women recently diagnosed HIV positive. [Controlled Clinical Trial Research Support, N.I.H., Extramural]. Women Health, 51, 546–565. https://doi.org/10.1080/03630242.2011.606356

Owczarzak, J., Broaddus, M., & Pinkerton, S. (2016). A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention. [Research Support, N.I.H., Extramural]. Health Educ Research, 31, 283–294. https://doi.org/10.1093/her/cyw012

Peltzer, K., Ramlagan, S., Jones, D., Weiss, S. M., Fomundam, H., & Chanetsa, L. (2012). Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: Results from a randomized trial. [Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. SAHARA J, 9, 218–226. https://doi.org/10.1080/17290376.2012.745640

Sarma, H., & Oliveras, E. (2013). Implementing HIV/AIDS education: Impact of teachers’ training on HIV/AIDS education in Bangladesh. [Research Support, Non-U.S. Gov't]. Journal of Health, Population and Nutrition, 31, 20–27. https://doi.org/10.3329/jhpn.v31i1.14745

Schwebel, F. J., & Larimer, M. E. (2018). Using text message reminders in health care services: A narrative literature review. [Review]. Internet Interventions, 13, 82–104. https://doi.org/10.1016/j.invent.2018.06.002CrossRefPubMedPubMedCentral

Shifaza, F., Evans, D., & Bradley, H. (2014). Nurses’ perceptions of barriers and facilitators to implement EBP in the Maldives. Advances in Nursing, 2014, 698604. https://doi.org/10.1155/2014/698604CrossRef

Skevington, S. M., Sovetkina, E. C., & Gillison, F. B. (2013). A systematic review to quantitatively evaluate ‘Stepping Stones’: A participatory community-based HIV/AIDS prevention intervention. [Review Systematic Review]. AIDS and Behavior, 17, 1025–1039. https://doi.org/10.1007/s10461-012-0327-6

Smith Fawzi, M. C., Siril, H., Liu, Y., McAdam, K., Ainebyona, D., McAdam, E., & Kaaya, S. (2019). Agents of change among people living with HIV and their social networks: Stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam Tanzania. BMJ Global Health, 4, e000946. https://doi.org/10.1136/bmjgh-2018-000946CrossRefPubMedPubMedCentral

Tso, L. S., Best, J., Beanland, R., Doherty, M., Lackey, M., Ma, Q., & Tucker, J. D. (2016). Facilitators and barriers in HIV linkage to care interventions: A qualitative evidence review. [Review Systematic Review]. AIDS, 30, 1639–1653. https://doi.org/10.1097/QAD.0000000000001101

Welbourn, A., & Stones, S. (1995). A training package on HIV/AIDS, communication and relationship skills. Action Aid London.

Wolf, H. T., Halpern-Felsher, B. L., Bukusi, E. A., Agot, K. E., Cohen, C. R., & Auerswald, C. L. (2014). “It is all about the fear of being discriminated [against]… the person suffering from HIV will not be accepted”: A qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya. BMC Public Health,14, 1–11. https://doi.org/10.1186/1471-2458-14-1154

Title: Barriers and Facilitators to Effective Implementation of the NAMWEZA Intervention in Dar es Salaam, Tanzania
Authors: Magreat Somba
Sylvia Kaaya
Hellen Siril
Kicki Oljemark
Donald Ainebyona
Elspeth McAdam
James Todd
Irene Andrew
Keith McAdam
Alice Simwinga
Neema Mleli
Samwel Makongwa
Sabina Haberlen
Mary C. Smith Fawzi
Publication date: 01-10-2021
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: Prevention Science / Issue 7/2021
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI: https://doi.org/10.1007/s11121-021-01230-x

At a glance: The STEP trials

Springer Medicine

Barriers and Facilitators to Effective Implementation of the NAMWEZA Intervention in Dar es Salaam, Tanzania

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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