South African Prevention and Treatment Intervention Study (SAPTIS)
Overview:
This project aims to test the effectiveness of HIV related interventions amongst truck drivers and sex workers at three border post sites in southern Africa (South Africa, Mozambique and Zimbabwe). Clinics have been set up at these sites via transport sector social responsibility programmes to enable individuals to obtain an HIV test and referral to public health facilities for treatment. This study focuses on ‘key’ mobile and migrant populations; that is, people who have a high risk of being infected with the HI-virus and/or a sexually transmitted infection (STI). This study is conducted at a time when there is interest within the transport sector in expanding these border post programmes but where no sound evidence on the effectiveness of these programmes in terms of linkage to care and HIV prevention.
Objectives:
The objective of this study is to test the effectiveness of interventions to strengthen the linkage to care from HIV testing to registration in a treatment programme. The study is designed to be of practical use in terms of assessing different means to bridge the gap in current health service practices and of strategic value in providing evidence in a context where there is little, on which to base programming decisions.
Furthermore, this study will undertake a cost effectiveness analysis to decide which intervention would be the most cost effective to scale up, as well as the impact it can have on a wider population. It also helps with policy planning to estimate the amount of funding that is required to secure a certain level of outcomes under a particular programme.
The final objective is to test the effectiveness of Short Message Service (SMS) technology to promote risk reduction behaviours amongst individuals attending RWCs and those not attending RWCs (both HIV positive and HIV negative individuals)– it makes use of the research context and conditions to include these individuals whilst also assessing whether a simple intervention is of value .
Methodological approach:
The first component of the project has been designed to determine whether SMS messaging and CD4 testing can improve the transfer of HIV positive individuals to a public health care facility for care and treatment (linkage to care intervention). In practice, this involves sending SMS messages to a sample population of individuals who test positive for HIV at the border post clinics to encourage them to register with a treatment programme. The purpose will be to see whether individuals follow that advice and, if so, how long it takes them to register with a treatment programme. Likewise, a different sample within the population of truck drivers and sex workers who test positive for the HI-virus at the clinics will be offered a CD4 analysis to see if the addition of this service increases the number of individuals who register on a treatment programme. With regards to both interventions above, there is an economic costing element which is detailed in the second component of the study (cost effectiveness analysis). The project also includes a third component that focuses on sexual risk reduction practices. This component determines whether health promotion messages transmitted via SMS to individuals within key populations is effective in reducing ‘risky’ sexual behaviour (by comparing reported practices before and after the intervention) (sexual risk reduction practices intervention) .