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Evaluating Botswana’s Campaign on Concurrent Partnerships using Coarsened Exact Matching
Iris Halldorsdottir, Noah Taruberekera, Rebecca Firestone, Lung Vu, Virgile Capo-Chichi, Richard Harrison
25 October 2012
Campaign background Campaign structure Impact evaluation Methods Results Lessons learned
Outline
PAGE 2
Goal: zero by 2016 2006 SADC Think Tank
– Key drivers: high CP, low levels of consistent condom use and male circumcision
National Operational Plan (2008-2010) – HIV Prevention scale-up focus on drivers
2007 CP Point Prevalence– 15-35 years, at least 1 partner– Men 17.5%, Women 17.4%
2007 CP Formative (Soul City) 2008 Development of CP
Campaign Plan
Background
page 3
Botswana’s Concurrent Partnerships CampaignCampaign team •National AIDS Coordinating Agency
•Natl Prevention Technical Advisory Cmte
•PSI
Campaign strategy •Teaser campaign – get people talking
•Phase 1 – address risk perceptions, knowledge, awareness of CP
•Phase 2 – assess consequences, personalize risk
Mechanisms•Social mobilisation – reach key influencers and leaders
•Mass media – TV, radio, print, billboards, combis• Interpersonal communication – CBOs, FBOs, door-to-door, bars/shebeens
Theory of change
page 5
Behaviour - harm reduction
within MCP
IPC
Direct exposur
e
Exposure from
all sources
Drivers of
individual behaviour
Opportunit
yAbility
Motivation
Intention to
avoid MCP
Behaviour-
reduce MCP
Reduced HIV inciden
ce
Community
sensitisation
Mass media
Integration
Key influencer
s
Media
Social diffusion
Institution
diffusion
Intention to
reduce harm within MCP
Adapted from Hornik and Yanovitzky, 2003
Did exposure to campaign messages among adults aged 18-35
(1) reduce concurrent partnerships and factors associated with having concurrent partnerships?
• Point prevalence of CP• Cumulative prevalence of CP
(2) increase HIV risk reduction behaviors and associated factors?
• Consistent condom use• HIV testing
Campaign evaluation questions
PAGE 6
National two-stage cluster sampling survey (n=1237)–Stage 1
• PPS sampling of enumeration areas (EAs) from census sampling frame• EAs in high exposure areas prospectively matched to EAs in low exposure areas,
based on geography and availability/coverage of radios and televisions– Stage 2
• Households within selected EAs selected using simple random sampling• One eligible individual in each household randomly interviewed.
Coarsened exact matching to compare exposed/non-exposed– Retrospective matching on radio and/or television access and or ownership, and
place of residence• L1 (Global Imbalance measure) = 0.059
Multiple logistic regression on sub-sample (n=1138)– Two exposure variables
• Exposure to at least one national campaign• Exposure to specific campaigns
– Stratification by gender
Evaluation Methodology
page 7
Descriptive statistics
page 8
Point preva-lence of CP
Cumulative prevalence of
CP
Consistent condom use
Ever tested for HIV
Campaign exposure
Employed Secondary education or
above
0
10
20
30
40
50
60
70
80
90
100
8.7
17.2
48.5
92.0
71.0
34.0
92.0
13.7
24.9
53.5
76.379.2
48.0
92.6
11.2
21.0
51.0
84.2
75.1
40.9
92.3
women
men
overall
Did campaign exposure reduce concurrent partnerships or increase HIV risk reduction behaviors?
Program exposure effects (vs. no exposure) on behaviors and behavioral factors
Adjusted OR (95% CI)
Effects for concurrency
Concurrency point prevalence 1.3 (0.8, 2.1)
Concurrency cumulative prevalence 1.1 (0.8, 1.6)
Peer pressure not to engage in CP 1.7 (1.1, 2.7)
Negative attitude to having variety of partners 1.6 (1.1, 2.3 )
Effects for HIV risk reduction
Consistent condom use 1.3 (1.01, 1.7)
Tested for HIV 1.6 (1.1, 2.4)
Condom use self-efficacy 1.4 (1.02, 1.8)
Perceived HIV risk 1.5 (1.1, 2.0)
• No evidence the campaign influenced concurrent partnerships
• Campaign was associated with HIV risk reduction behaviors
Campaign effects concentrated in men
PAGE 10
Program exposure effects (vs. no exposure) by gender
Men AOR (95% CI) a
Women AOR (95% CI) a
Effects for concurrency
Negative attitude to having variety of partners 2.0 (1.3, 3.1) 0.9 (0.4, 1.7)
Effects for HIV risk reduction
Consistent condom use 1.7 (1.1, 2.6) 1.1 (0.7, 2.8)
Condom use self-efficacy 1.6 (1.02, 2.4) 1.2 (0.8, 1.9)
Perceived HIV risk 3.0 (1.9, 4.6) 0.8 (0.5, 1.2)
Cross-sectional survey Recall bias Not fully nationally representative, but equally
covered low and high implementation areas
Limitations
PAGE 11
Conclusions
page 12
Campaign exposure was associated with risk reduction strategies - more consistent condom use; greater HIV testing; greater confidence in condoms as an HIV risk avoidance strategy
Risk reduction effects primarily concentrated among men, along with some evidence of changes in attitudes to view sexual networking more negatively
Stand-alone campaigns on concurrency likely not sufficient in duration or intensity to change a culturally entrenched, socially tolerated behaviour
Adults in this context need a range of HIV risk reduction strategies
Combination prevention
Clear identification of the counterfactual Only one round of data required Superior to other common matching methods in the
quality of the match it can provide Easy to implement with the right software
Lessons learned in using CEM
page 13
National AIDS Coordinating Agency, Bostwana Centers for Disease Control and Prevention US Agency for International Development/Pepfar
Contact: [email protected]
Acknowledgements
page 14