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					Evaluation of multi-country social
marketing programs for increasing
demand for VCT




 Dvora Joseph, MPH, HIV/AIDS Service Delivery Manager
     Kerry Richter, PhD, Deputy Director - Research
        Shannon England, MPH, Program Manager

              Population Services International
             Social Marketing and Behavior Change Worldwide
       Objectives of the Presentation:

     Share formative research on perceived
      barriers and motivations for voluntary
      counseling and testing for HIV (VCT or CTR)
      = Creation of social marketing campaign to increase
        demand for VCT
     Present data that on the effectiveness of VCT
      social marketing campaigns and impact on:
      • Uptake of VCT services among target groups
      • Perception of importance of VCT
      • Intent to seek out VCT in the future

2
               Background:
    Rationale for VCT Social Marketing:
     90% of those who are HIV+
      don’t know their status
     At current rate of testing,
      90% of the 12,000 people
      who will be infected with
      HIV today won’t know until
      2013
     Existing VCT services
      inadequate or poor quality
     Services not reaching those
      at highest risk or most
      vulnerable populations


3
      PSI’s Response: Social Marketing
                  for VCT
    Objective: To expand access to and demand for VCT
    services among target groups by:
     • creating networks of high-quality VCT sites (often through
       social franchising)
     • enabling VCT sites to meet on-going (and growing)
       consumer demand for services through technical
       assistance and support, regular monitoring for quality
     • creating consumer demand for VCT services through
       social marketing/ behavior change communications


4
    PSI VCT Programming Worldwide – in
               20 Countries
    •   Zimbabwe     - Benin
    •   Zambia       - Uganda
    •   Rwanda       - Swaziland
    •   Mali         - Myanmar
    •   Mozambique   - Lesotho
    •   Namibia      - South Africa
    •   India        - Cambodia
    •   Togo         - Cote d’Ivoire
    •   Haiti        - Vietnam
    •   Kenya        - Madagascar (in development)

5
      Multi-country summary of
       formative research


What motivates people
   to get tested?




                        Man testing in Mozambique
                Qualitative Research:
        Perceived Motivators for Seeking VCT
    - Planning for the Future
         - Getting Married
         - Having a Child
    - Partner or Child Dies or is ill
    - Past Risky Behaviors
    - Partner’s Risky Behaviors
    - Prevention (protect others and self)
    - Personal relationships with PLWHA and desire to
      know status
    - Recommended/Advised by others (including
      medical referrals)
    - Desire counseling on living a healthy life


7
                               Top Reasons for Seeking VCT:
                                           MOTIVATIONS FOR SEEKING VCT SERVICES (2004)
                                                   Nambia, Zimbabwe, India, Zambia
                         80%
                                                                                              Namibia [N=15,510]
                         70%                                                                  Zimbabwe [N=131,000]
                                                                                              India [N=21,744]
                         60%                                                                  Zambia [N=10,935]
    Percent of Clients




                         50%


                         40%


                         30%


                         20%


                         10%


                         0%
                                Referral       Worried about   Client, partner or     Planning to        Wants more
                                             status/have high-  child are HIV+/     marry/have child     counseling/
                                               risk behavior     sick or at risk                          retesting/
                                                                                                       confirmatory test




8
    Perceived Barriers to VCT:
What prevents at risk individuals from
           seeking VCT?
         Perceived barriers to VCT remain
                    including:
        Fear of HIV+ result
        No Cure
        Lack of access to or knowledge of treatment
        Perceived Lack of Confidentiality
        Lack of Trust in Accuracy of Test
        Unfamiliar with VCT or don’t know where to go
        Belief VCT is only for promiscuous, sick or
         dying people (highly stigmatized)


10
      Kenya: Reasons for NOT getting tested,
                  2005, N=2334

     100
      90
      80
      70
      60
      50
      40
      30
      20
      10
       0
           Fear of       Fear of     Fear of   No cure      Fear of     No need
           testing    'going down'    death              losing one’s
           positive    or reaction                            job


11
        Following Formative Research:
     Started off with a Marketing Challenge

 Creating demand for a service:
    With high latent need (but no perceived need)
    With possibilities of being highly stigmatized
    Capable of making frightening revelations
    Whose benefits are neither tangible nor clear
    That initially promised no curative or medical
     back up . . And preventive benefits not
     understood

12
          VCT Communication Strategy
     Started off challenging the
       notion that:
     Knowledge of HIV status = Loss
       of hope or illness, death

     Positioning based on initial
       consumer research:
     Main benefits promoted as
       “Hope” and “peace of mind”
     An opportunity to begin life once
       again . . . with a . . .
      High quality, professional
       service . . . that is . . .
      Anonymous and Confidential
       and
      At a reasonable cost . . . and is
      Conveniently located and
       operated too . .

13
                    Brand Name & Logo
 Brand name: Implying a new
  beginning in life
 Logo: Depicting “Hope”
  through rising sun and
  vibrant colors
 Product description:
  “Counseling and Testing
  Centre” (Not “HIV/AIDS
  center”)
 Includes desired action    New Start Branded VCT sites in 9
  (behavior change) right in countries in Africa
  slogan itself:
  “Make a New Start Today!”
14
     VCT Promotions for New Start in Zimbabwe




15
               Evaluation of Multi-country
                Program to Promote VCT
                                            Methods used to
                                             assess impact of
                                             SM campaigns
                                             include:
                                             • Qualitative research
                                             • Population-based
                                               surveys
                                             • Clinic-based data
     Drawing Blood in VCT Site: Cambodia




16
     Is Mass Media an Effective Way to Promote VCT?
                                                   How do clients learn about VCT?

                                                      SOURCE OF VCT INFORMATION
                                                   Namibia, Zimbabwe, India, Zambia (2004)
                           90%                                                              Namibia [N=15,510]
                                            82% 82%
                                                                                            Zimbabwe [N=131,000]
                           80%
                                                                                            India [N=21,744]
                           70%
                                      64%
                                                                                            Zambia [N=10,935]
                           60%
       Perent of Clients




                           50%


                           40%


                           30%
                                                                      22% 22%
                                                          19%
                           20%                                                       17%
                                                                14%

                           10%                                                  8%
                                 5%                                                                  5%         4%   4%
                                                                                           2%   2%
                                                                                                           0%
                           0%

                                      Television                Radio           Posters/ Outdoor          Newspaper
                                                                                   Promotion


17
     Knowledge and Attitudes Towards VCT
      Among Youth Ages 13-24, Zambia,
                2001 and 2004
                                        2001             2004
                                    %          (N)   %          (N)
       Knows a place to get a
                                    62.8   (2400)    73.8*   (2400)
         HIV test
       Sexually active youth
         reporting ever testing      7.7   (1696)    22.8*   (1389)
         for HIV
       Sexually active youth
         reporting interest in      71.9   (1696)    88.0*   (1389)
         getting HIV test
       Sexually active youth
         reporting intent to seek   76.4   (1696)    78.2*   (1389)
         VCT in next 12 months

           *=p<.05

18
      2004 PSI Tracking Survey – Results
                   in Kenya
      Nearly 90% of males and females aged 15-35
       are aware of confidential HIV testing
      32% have ever been tested; 23% of the total
       sample has ever received a voluntary test
      Among those who have never been tested
       (n=1589), 70% expressed interest in taking a
       test in the future



19
     Knowledge, Attitudes, and Behaviors towards VCT among
           General Population aged 15 –34, Zimbabwe



      80%
                                         2001
                                                 69%
      70%                                2004
                                  62%
      60%
                            51%
      50%                                  46%

      40%

      30%

      20%
                  13%
      10%
             8%

       0%
                             New Start




                                            next 12m
             Sexually




                                            Intent to
              Tested
              Active
              Youth




                                             test in
                              Names
               Been




                               Site




20
What about in a low prevalence
          setting?
    Operation Project Lighthouse
            (OPL), India
Promotion of VCT in low prevalence setting:
               OPL- India


                 Video van     Outreach
                 activity     worker in a
                 for clinic     1: group
                 promotion       session




                                            Mobile
                                            interaction
Street Play                                 point near
in progress                                 the mobile
                                            van
22
     Communication Channels
         Mass Media

                                           “ I went to Saadhan
                                          clinic. Not only did
                                          I get HIV testing but
      Press                              also a start to healthy
                                                 new life”




     Mass Media and IPC focus on positive benefits of testing
23
     Impact of Targeted VCT
     Communications in India
                                   2002         2004
                                 BCIS I (%)   BCIS II (%)
     Knows a place they could        26          63*
       go for an HIV test
     Adult males reporting
       ever been tested for          1            5*
       HIV
     Adult males reporting
       importance of getting        55           77*
       tested for HIV
     Adult males reporting
       intent to get VCT in           21         56*
       next 12 months
                            N=     7,245       10,100

24    *=p<.05
                    Conclusions
      Social marketing of VCT using mass
       media and IPC focusing on the positive
       benefits and importance of VCT (whether
       + or -) is an effective means of promoting
       VCT and decreasing stigma around HIV
       testing.
      More analysis is needed to assess the
       best way to promote and deliver cost-
       effective VCT to high-risk groups in
       lower-prevalence settings (including IPC
       & involvement of PLWHA)
25
               For More Information

        Dvora Joseph
          Population Services International
          Washington, DC
          Email: djoseph@psi.org
          www.psi.org




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