Evaluation of a multi-sector HIV capacity-building program in Nairobi informal settlements Open Access

Purvis, Danielle (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/xw42n8124?locale=en
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Abstract

Background : HIV incidence remains high in informal settlements of Nairobi informal settlements compared to the rest of Kenya. Many HIV interventions do not address the causes and the consequences of HIV concurrently, and most programs in informal settlements are not sustainable due to reliance on external donors. The current study is an evaluation of a leadership development program designed to mobilize community assets, develop collaborations, address social structural determinants of HIV, and improve HIV prevention and care practices. Methods: Eight multi-sector teams based in Nairobi informal settlements participated in the Faith, Health Collaboration and Leadership Development Program (FHCLDP) from February to August 2015, which utilized a pedagogy that enhances community mobilization through participatory learning, action planning and implementation, and the engagement of stakeholders from multiple sectors. Researchers conducted a thematic analysis of workshop documents, team reports, and site visit field notes to determine the influence of the program on team practices following workshops. Findings: Teams effectively mobilized community assets, formed and strengthened collaborations, addressed most social structural determinants of HIV, and implemented HIV prevention and treatment interventions. However, it is unclear how the program influenced HIV prevention and treatment practices, and no teams addressed structural determinants of HIV (e.g., poor infrastructure). Interpretation: The FHCLDP demonstrates potential to build capacity in teams in low-resource communities to implement interventions that address the causes and consequences of HIV. Teams alleviated donor dependency by mobilizing local resources and strengthening local stakeholder relationships. In addition, they addressed pressing determinants of HIV while reinforcing care infrastructure in their informal settlements. Recommendations for the FHCLDP are provided.

Table of Contents

Table of Contents

Executive Summary 1

Problem 1

Aim of the Current Study 1

Approach of the Current Study 1

Findings 1

Conclusions 2

Recommendations for the FHCLDP 3

Introduction 4

Problem Statement 4

Program Overview 4

Statement of Purpose 4

Background 5

Overview of HIV in Kenya 5

HIV in Nairobi Informal Settlements 6

Determinants of HIV in Nairobi Informal Settlements 9

Limitations in HIV Interventions in Informal Settlements 18

Recommendations for HIV Interventions 19

Purpose Statement 21

Research Questions 21

Methods 23

Program Overview 23

Study Population 28

Data Collection 30

Definition of Variables 32

Data Analysis 34

Results 36

Participants' Perceptions of the Program 36

Influence of Determinants on Team Practices 39

Influence of Curriculum on Team Practices 44

Barriers to Team Practices 58

Discussion 60

Public Health Implications 66

Limitations of the Current Study 67

Recommendations for the FHCLDP 69

Conclusion 69

References 71

Appendix 75

Appendix A: Call for Applications 75

Appendix B: Curriculum Overview 78

Appendix C: Case Studies 86

Appendix D: Community Asset Maps 89

Appendix E: Network Maps 90

Appendix F: Post-Workshop Surveys 92

Appendix G: Community Action Learning Guidelines 100

List of Tables and Figures

Tables

Table 1: Program and Data Collection Timeline 24

Table 2: Overview of Workshop 1. 25

Table 3: Overview of Workshop 2. 26

Table 4: Post-workshop Survey Assessment of Workshop Effectiveness 37

Table 5: Pre- to Post-Workshop Assessment of Participant Self-Efficacy 38

Table 6: Curriculum Overview 45

Table 7: Influence of Curriculum on Social Structural Practices 50

Table 8: Influence of Curriculum on HIV Interventions 55

Figures

Figure 1: Team Community Asset Map in Workshop 2. 47

Figure 2: Team Network Map in Follow-up Meeting 48

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