Health diplomacy and Adapting global health interventions to local needs: findings from project accept (HPTN 043), a community-based intervention to reduce HIV incidence in populations at risk in Sub-Saharan Africa and Thailand

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  • Kevany, Sebastian
    • Other Affiliation: Institute for Health Policy Studies, Center for AIDS Prevention Studies, University of California, San Francisco, USA
  • Khumalo-Sakutukwa, Gertrude
    • Other Affiliation: Institute for Health Policy Studies, University of California, San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA
  • Murima, Oliver
    • Other Affiliation: University of Zimbabwe, Harare, Zimbabwe
  • Chingono, Alfred
    • Other Affiliation: University of Zimbabwe, Harare, Zimbabwe
  • Modiba, Precious
    • Other Affiliation: Perinatal Health Research Unit, Soweto, South Africa
  • Gray, Glenda
    • Other Affiliation: Human Sciences Research Council, Durban, South Africa
  • Van Rooyen, Heidi
    • Other Affiliation: Human Sciences Research Council, Durban, South Africa
  • Mrumbi, Khalifa
    • Other Affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  • Mbwambo, Jessie
    • Other Affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  • Kawichai, Surinda
    • Other Affiliation: Chiang Mai University, Chiang Mai, Thailand
  • Chariyalertsak, Suwat
    • Other Affiliation: Chiang Mai University, Chiang Mai, Thailand
  • Chariyalertsak, Chonlisa
    • Other Affiliation: University of Zimbabwe, Harare, Zimbabwe
  • Paradza, Elizabeth
    • Other Affiliation: University of Zimbabwe, Harare, Zimbabwe
  • Mulawa, Marta
    • Other Affiliation: Medical University of South Carolina, Charleston, USA
  • Curran, Kathryn
    • Other Affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA
  • Fritz, Katherine
    • Other Affiliation: International Center for Research on Women, Washington, DC
  • Morin, Stephen F
    • Other Affiliation: Institute for Health Policy Studies, University of California, San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA
Abstract
  • Abstract 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.
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Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Sebastian Kevany et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Public Health
Journal volume
  • 12
Journal issue
  • 1
Page start
  • 459
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2458
Bibliographic citation
  • BMC Public Health. 2012 Jun 20;12(1):459
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • January 23, 2013

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