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Malawai: A Primary Health-Care Model for HIV Prevention

“Mzake ndi Mzake (Friend to Friend) Peer Group Intervention for HIV Prevention : a PHC model” is a multisite project that enables the primary care system and volunteer health workers to work on HIV prevention with adults and adolescents in rural areas.

The project was developed and implemented by nursing faculty at the University of Malawi Kamuzu College of Nursing and the University of Illinois at Chicago College of Nursing (United States). Nurses and community health workers play a crucial role as peer leaders in their communities, and as trainers of peer leaders.

To date the service has been funded through research grants from donors, including the Fulbright Scholarship Program (1999–2000), the United States National Institute of Nursing Research (2001–2008) and the World AIDS Foundation (2003–2005). Local funding is being sought to continue and extend the intervention to other sites.

The intervention delivery system is built on the primary care model of health worker–community collaboration. It integrates social-cognitive learning for behavioural change with cultural tailoring and gender sensitivity. It is organized and evaluated by the two faculties and delivered by trained health workers and community adults who work in pairs as peer leaders. Six interactive group sessions are convened to discuss the need for HIV prevention, human sexuality, how HIV and other infections are sexually transmitted, prevention strategies, partner negotiation, correct condom use, and how to spread the message in the community.

The team has trained 855 health workers in the urban referral hospital, 333 district health workers, 60 community leaders, 2,242 adults and over 1,500 young people in the rural communities. In terms of outcomes, improvement is evident in all groups with respect to: HIV-related knowledge; attitudes to condoms and testing; self-efficacy for practising safer sex and talking with partners about HIV prevention; and community HIV-prevention activities. All adults show more favourable attitudes to the use of condoms. Risky sexual behaviour has decreased among district health workers and adults, and condom use has increased among sexually active adults and adolescents. Urban and district health workers show improvements in universal precautions and client teaching, but urban health workers show no change in safer sex practices.

 

Explore the entire Compendium of Primary Care Case Studies (2009) published by the World Health Organization.