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

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

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

11. “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

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

13. “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

14. “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)”

15. “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.

16. 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)
Feb, 07 – Jun, 08 (edutainment)

17. 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) 
Jan – Dec, 06 (daytime) % %
Feb, 07 – Jun, 08 (edutainment) % %
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).”

18. 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.

19. 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
U01MH (Johns Hopkins University)
U01MH (Medical University of South Carolina)
U01MH (University of California, Los Angeles)
U01MH (University of California, San Francisco)

20. 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

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

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

23. Acknowledgement

24. THANK YOU For more information on Project Accept
Speaker contact information:
Surinda Kawichai