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