NIMH Project Accept (HPTN 043) HIV/AIDS Community mobilization (CM) and Mobile HIV voluntary counseling and testing (MVCT) utilization in rural Thai

NIMH Project Accept (HPTN 043) Study Group HIV/AIDS Community mobilization (CM) and Mobile HIV voluntary counseling and testing (MVCT) utilization in rural Thai Surinda Kawichai1, 2, Suwat Chariyalertsak2, Kriengkrai Srithanaviboonchai2, Surasing Visaruratana1, Becky Genberg1, Kanokporn Panchareon2, Monjun Wichajarn2, Chonlisa Chariyalertsak3, Christopher Gordon4, David D. Celentano1 1Johns Hopkins University, Bloomberg School of Public health 2Chiang Mai University, Research Institute for Health Sciences 3Thai Ministry of Public Health, Chiang Mai Public Health Office 4National Institute of Mental Health (NIMH) For NIMH Project Accept (HPTN 043) Study Group

Background In 2003, the U.S. National Institute of Mental Health (NIMH) decided to fund an HIV community-level sampling approach prevention trail “A Phase III Randomized Controlled Trail of Community Mobilization, Mobile Testing, Same-Day Results, and Post-test Support for HIV in Sub-Saharan Africa and Thailand” Primary Objective: to determine the efficacy of behavioral/social science intervention with an HIV incidence endpoint

Background A total of 48 communities from five sites in four countries were selected for this study; 16 from two sites in South Africa, 10 in Tanzania, 8 in Zimbabwe, and 14 in Thailand Matched pair the selected communities Randomized Standard clinic-based VCT (SVCT) Community-based VCT (CBVCT) + SVCT

Background Community-based VCT 3 major strategies 1) to make VCT available in community setting (MVCT) 2) to engage the community through outreach for HIV/AIDS education and encourage VCT (Community Mobilization: CM) 3) To provide post-test support (PTSS) **These strategies are designed to change community norms and reduce HIV risk behaviors among community members, irrespective of whether they participate directly in the intervention

Background THAILAND Launched the intervention in January 2006. CHIANGMAI Mae-ai Fang Chai-pra-karn Praow Chiang-dao Mae-tang Myanmar Thailand Study sites Six districts of north Chiang Mai Province, Northern Thailand THAILAND Muang district Approximately 40% of the community populations are ethnic minorities Launched the intervention in January 2006.

education and discussion Community Mobilization (CM) and MVCT Strategies during the first year of intervention Small HIV/AIDS group education and discussion During Daytime - Door to door visits MVCT followed CM 2-3 days with designated place and time. - Joining community organized meeting

Limitations - Missing target population - Lack of interest in HIV/AIDS (18-32 years of aged) - Lack of interest in HIV/AIDS education sessions limited time for the project at community organized meeting

Lessons learned during the first year of intervention Social entertaining events like a fair ground were apparently drew attention and participation from community members People did ask for VCT at such the events

New approach of Community Mobilization and MVCT - Started in February, 2007 - Introduced HIV/AIDS “edutainment” (education and entertainment) and VCT in the evening hours.

“Edutainment” Three bases of interactive HIV/AIDS and VCT mobilization activities 1) HIV/AIDS interactive group education and discussion 2) Prevention and How to use condom 3) HIV/AIDS awareness games

Encouragement for full participation to mobilization activities Participated all three bases then get a prize

“Edutainment” VCT services corners Fun Activities - Karaoke kiosk (often times a contest) VCT services corners Movies (most HIV/AIDS related and in ethnic minorities languages) Health related activities - Blood pressure check up

“Community participation” Contribution from community leaders, gatekeepers, and community health workers were VERY important This is one of Project Accept’s main components of community mobilization each site recommended to set up “community Working Groups (CWGs)” (in which community leaders, gatekeepers, community health workers are members), and “Community-Based outreach Volunteers (CBOVs)”

“Community participation” At the Thai site; CWGs have been established in each community. Had meeting with them every time prior to enter the community to provide the services to seek their help and advise. Get community respective figures include monks and priests to learn about HIV/AIDS Working with religion organizations which involve HIV/AIDS for training monks and priests in the intervention communities on HIV/AIDS issues.

Results # VCT field days # VCT clients # of CM participants increased substantially VCT uptake were increased On average from 18 to 28 persons per day # VCT field days # VCT clients Jan – Dec, 06 (daytime) 160 2820 Feb, 07 – Jun, 08 (edutainment) 251 6984

Results Edutainment was more attractive and promote VCT among younger people, - overall median age of VCT clients decreased from 38 to 35 years old (p<0.001) Age (years)  20 16 - 30 Jan – Dec, 06 (daytime) 13% 35% Feb, 07 – Jun, 08 (edutainment) 19% 41% Edutainment can reduce VCT stigma “I come here to join my friends for Karaoke but I am early so I decided get VCT while waiting (for friends).”

Conclusions Providing free mobile VCT in community public setting along with entertainment and education (during evening hours) attractive to young adults and at risk persons increased VCT uptake, can eliminate VCT stigma.

the U.S. National Institute of Mental Health Acknowledgement This research was sponsored by the U.S. National Institute of Mental Health as a cooperative agreement, through contracts U01MH066687 (Johns Hopkins University) U01MH066688 (Medical University of South Carolina) U01MH066701 (University of California, Los Angeles) U01MH066702 (University of California, San Francisco)

Acknowledgement In addition, this work was supported by the HIV Prevention Trials Network (HPTN Protocol 043) of the Division of AIDS of the U.S. National Institute of Allergy and Infectious Diseases and by the Office of AIDS Research of the U.S. National Institutes of Health Views expressed are those of the authors, and not necessarily those of sponsoring agencies

Acknowledgement We thank the communities that partnered with us in conducting this research, and all study participants for their contributions

Acknowledgement We also thank study staff and volunteers at all participating institutions for their work and dedication

Acknowledgement

THANK YOU For more information on Project Accept www.cbvct.med.ucla.edu Speaker contact information: Surinda Kawichai E-mail: skawicha@jhsph.edu