CD4<350HIV- VL<50 CD4>250HIV+
Primary prevention: prevention of diseases
and conditions before biological onset
Secondary prevention: the identification and
interdiction of diseases that are present in
the body, but that have not progressed to
the point of causing signs, symptoms, and
dysfunction
Tertiary prevention: the prevention of
disease progression and suffering after it is
clinically obvious. It prevents morbidity and
mortality
Retention through Motivation
Prevention…
Definition adapted from: Robert B Wallace, The Gale Group Inc
VCT(+):
Confidential HIV screening, CD4 staging, TB
questionnaire, referral
VCT+ is not an outcome
VCT+ entry point into a continuum of care
100% uptake of target group
Annual VCT+
Prevalence & incidence
VCT+ …
Retention Strategies Applied in the Community
Intensive adherence management
Childcare program
Sports program
Drama and music
Theatre “The Miracle”
Entrepreneurship
Retention through motivation
•Community participation
•Family involvement
•Integrated into Social Mobilisation
•Integrated into Primary Healthcare
CHAMP Prevention program
Outcome measures of success…
Primary prevention: reduced Prevalence &
Incidence (VCT+, CD4, stigma)
Secondary prevention: earlier care seeking
behaviour (VCT+, CD4, stigma)
Tertiary prevention: lowered morbidity &
mortality
Retention for life – motivation &
destigmatisation
Some early results…
010
020
030
040
0m
ean
of c
d4co
unt
0 1
Mean baseline cd4 count at clinic (0=NMC, mean baseline cd4 count=189.5 cells/ul) and Outreach patients (1= Outreach patients, mean baseline cd4 counts= 341.7cells/ul)
Mean Baselines
What has gone wrong with past strategies
• Atheoretical not informed by behavioural science
models
• Target groups not assessed, messages not tailored
to target population,
• Messaging too broad with a general focus
• Information without practical advice
• Fail to motivate, do not teach behavioural skills
• Not rigorously evaluated
• Not disseminated widelyFisher, JD SA AIDS conference 2009. Changing AIDS-Risk behaviour
010
2030
40m
ean
of a
ge
0 1
Mean Ages
0 1
1 2
Graphs by time
Sex distribution
Female Male
Thank you Questions & Discussion