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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Health diplomacy the adaptation of global health interventions to local needs in sub-Saharan Africa and Thailand: Evaluating findings from Project Accept (HPTN 043)
BMC Public Health, Volume 12, No. 1, Article 459, Year 2012
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Description
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. © 2012 Kevany et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Kevany, Sebastian
United States, San Francisco
University of California, San Francisco
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Khumalo-Sakutukwa, Gertrude N.
United States, San Francisco
University of California, San Francisco
Murima, Oliver
Zimbabwe, Harare
University of Zimbabwe
Chingono, Alfred H.
Zimbabwe, Harare
University of Zimbabwe
Modiba, Precious
South Africa
Perinatal Health Research Unit
Gray, Glenda E.
South Africa, Pretoria
Human Sciences Research Council of South Africa
Van-Rooyen, Heidi E.
South Africa, Pretoria
Human Sciences Research Council of South Africa
Mrumbi, Khalifa
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mbwambo, Jessie Kazeni Kilonzo
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Kawichai, Surinda
Thailand, Chaing Mai
Chiang Mai University
Chariyalertsak, Suwat
Thailand, Chaing Mai
Chiang Mai University
Chariyalertsak, Chonlisa
Zimbabwe, Harare
University of Zimbabwe
Paradza, Elizabeth
Zimbabwe, Harare
University of Zimbabwe
Mulawa, Marta I.
United States, Charleston
Medical University of South Carolina
Curran, Kathryn G.
United States, Seattle
University of Washington
Fritz, Katherine E.
United States, Washington, D.c.
International Center for Research on Women
Morin, Stephen F.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 17
Authors: 17
Affiliations: 10
Identifiers
Doi:
10.1186/1471-2458-12-459
e-ISSN:
14712458
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
South Africa
Tanzania
Zimbabwe