Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12003
Country/Region: Botswana
Year: 2010
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health Center for Communication Programs
Organizational Type: University
Funding Agency: USAID
Total Funding: $0

Brief Description of Study

The link between alcohol consumption and HIV sexual risk behavior is believed to be an important contributor of new HIV infections in Botswana. Interventions to break or minimize this link are often complex if not controversial. The plan is to conduct a formative research followed by a continuous surveillance activity to inform program development and decision making around the issue of alcohol use and HIV infection. This study aims to adapt and implement a time location sampling (TLS) protocol for use as an Integrated HIV Behavioral Surveillance Survey (IHBSS) in Gaborone, Botswana. The proposed TLS will entail formative research to identify a comprehensive "universe" of locations where alcohol is consumed (e.g., bars, bottle stores, and other legal alcohol-consuming venues) and their attendance patterns, a random sample of all possible Venue, Day and Time (VDT) periods when the alcohol-consuming locations are attended, consecutive recruitment of eligible adults at each selected VDT until the desired sample size is reached, and adjusted analysis to account for venue attendance patterns and clustering. The target population will be adult men and women attending the alcohol-consumption venues.

The research will also assess the feasibility of implementing HIV sentinel surveillance among this target population at alcohol-consumption venues in the future.

The objectives of the study are;

1. To adapt and implement a Time Location Sampling (TLS) protocol for use as an Integrated HIV Behavioral Surveillance Survey (IHBSS) in Botswana

2. To estimate HIV prevalence among men and women attending alcohol-consumption venues

3. To estimate risk behaviors associated with HIV transmission

4. To develop the capacity and skills of in-country collaborators at the MOH to implement TLS surveys in the future.

Study Design

A contextual assessment will be carried out prior to the development of the research protocol. A description of the contextual assessment and the draft in-depth interview questions will be presented to IRB at JHU/SPH and in Botswana requesting exemption from research for this phase of the study, prior to embarking on the site visit.

The primary goal of the contextual assessment is to understand better the local context and the logistics of conducting behavioral and biological assessments, and to use this information to develop a research protocol that is specific to the city of Gaborone.

Secondary goals include collaborating with study partners, establishing local processes to support the study, and conducting a workshop in TLS Mapping for a local research firm.

The TLS method will be conducted in three phases:

1. Mapping of the universe of venue-day-times, culminating in the development of a sampling frame

2. Random selection of venues-day-times and alternates for the development of monthly sampling calendars

3. Enumeration, participant recruitment and data collection

Study sites:

Alcohol drinking venues in Gaborone that satisfy the Time Location Sampling eligibility selection criteria

Although multiple links between alcohol use and transmission of HIV infection are well documented in the literature, limited research has been done in this area in Botswana, and little is known about rates of HIV infection and risk-taking behaviors among alcohol users in Botswana, specifically in the social context of alcohol use. Prior studies have mainly been population-based household surveys or clinic-based samples that did not explore environmental influences on behavior and risk. This is the first venue-based survey of alcohol users in Gaborone; this approach recognizes that behavioral risk for HIV infection may differ within the physical context that supports drinking behaviors compared to other environments. It aims to better understand the burden of HIV in Botswana by describing the epidemiology, scope, level of risk, and possible drivers of the HIV infection epidemic among alcohol consumers in the places where they drink. The study will also characterize the individual vulnerabilities and venue-based factors that may influence the relationship between alcohol use and risk of HIV. Results may be useful in the development of targeted HIV prevention programs that focus interventions in the places where they matter most, such as alcohol-consumption venues. A comprehensive strategy will diversify prevention approaches and simultaneously assess and intervene not only among alcohol-users, but also the different drinking environments enabling the inter-related behaviors that increase one's risk of acquiring HIV infection.

Subpartners Total: $0
Premiere: NA
Key Issues Identified in Mechanism
Addressing male norms and behaviors
Mobile Populations