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project > DESCRIPTION OF THE PROJECT
General objectives

The project's general objective is to promote SRH of PLWH and to prevent further transmission of HIV to their sexual partners by addressing health determinants that contribute to adopting healthy sexual lifestyles, thus contributing to an improvement of their quality of life. The strategy proposed to achieve this objective consists of setting up a large and multidisciplinary European network of experts in SRH related to HIV (both old and new EU member states included).
 



The project aims at preventing transmission of HIV and other STDs from PLWH to their sexual partners by:
improving current strategies of secondary prevention of HIV and prevention of other sexually transmitted infections (STIs) including the prevention of the spread of resistant HIV-strains; sexual problems;
empowering PLWH to take informed choices about fertility issues (such as family planning and contraception), pregnancy-related issues and sexual problems related to HIV.
The general objectives can be seen as a contribution to further increasing the quality of life of PLWH. In addition, improving secondary prevention will also significantly enhance current primary prevention efforts and thus curb the spread of HIV and other STIs in Europe.


Specific objectives

The specific objectives are set out at four levels:
Identifying SRH needs of men/women living with HIV using sound scientific and gender-sensitive methodologies. Target-groups addressed are men having sex with men, ethnic minorities, heterosexual men and women, and PLWH with a current or past (IV) drug use history. Areas to be covered are: secondary prevention, sexual problems, fertility, and pregnancy-related issues.
Identifying, analysing and disseminating models of best practice across Europe on the basis of the needs identified. Identifying existing barriers to the integration of HIV and SRH on a policy level.
Developing policy recommendations and guidelines on the basis of the available best-practice evidence for an integrated field of HIV/Aids and SRH and to disseminate them among the member states.
Setting up a network of experts in an integrated area of SRH and HIV/Aids in EU member states that actively promotes the SRH of PLWH.
The first and the second objective respectively need to be fine-tuned in concrete terms as to specify the actual research to be carried out, thus translating them into concrete research questions and define the research protocol. Data collected to answer the research questions will serve as an evidence base for defining best practices in the field of SRH:
(1) What are predictors of sexual high-risk behaviour among PLWH?
(2) Taking a comprehensive definition of SRH into consideration, what are specific support needs of PLWH (e.g. contraceptive needs and family planning; avoiding relapse behaviour and maintaining safer sex behaviours, etc.)
(3) How can optimal strategies for delivering risk reduction counselling in HIV care settings be defined (based on assessed evidence of SRH-needs of PLWH)?


Methods

Appropriate quantitative and qualitative research tools will be developed to assess problems and needs related to sexual health of PLWH. The research can be separated into different data assessment steps.

Data assessment step 1 : Elicitation research using focus groups

In order to assess accurately the research topic, we decided to start with an elicitation research phase adopting qualitative research methods such as focus groups. Conducting focus groups is a qualitative data assessment technique that allows to produce a lot of information quickly and at less cost than individual interviews. It is seen as useful for identifying and exploring bliefs, attitudes, opinions, and behaviours (1).

Using focus group methodology, issues relevant to SRH needs of PLWH and to prevention for positives can be addressed in various settings and with various target groups, such as homosexual men, heterosexual men, heterosexual women and members of minority groups. Although we focus primarly on doing focusgroups with health care workers (HCW). Our aim is to carry out focus groups at tree different groups of HCW (physicians, nurses, social workers). Concerns in terms of both recruiting issues as well as collecting unbiased information from PLWH directly have been considerable. In addition, our objective for the qualitative research is not so much to gain in-depth understanding itself, but set the research priorities for designing the quantitative instrument. Evidence elicitated by collecting information from health care workers will be usefull in doing so. Partners who are in a position to access PLWH directly and who are capable of doing additional qualitative research are encouraged to do so.

A focus group guideline will be developed in English, containing a general and more specific questions. Focus group sessions will have to be audiotaped and transcribed, to enable subsequent analytic induction and comparative analysis.



(1) Stimson GV, Donoghoe MC, Fitch C, Rhodes T (2001). Rapid Assessment and Response Technical Guide. World Health Organization: Department of Child and Adolescent Health Development and Department of HIV/Aids, Geneva


Data assessment step 2: Compiling evidence in general populations of PLWH
using quantitative data collection


Based on the results of the focus groups a self-reported questionnaire will be developed to assess data cross-sectionally. Using this questionnaire, a survey will be carried out to assess the problems and needs related to SRH among PLWH.

Data obtained will reflect a more general picture of sexual risk behaviours, its determinants, as well as feasible ways of reducing them in the context of professional HIV-care and support.

Questionnaires will be drafted in English, translated by the participating teams, and re-translated into English in order to assure the qualities of the translation and achieve comparable data throughout the participating countries.

This instrument will be piloted in a sample of HIV+ patients, adapted on the basis of the pilot results and subsequently used within the general population of PLWH being followed at the various HIV-treatment centres represented in the EUROSUPPORT network.

After having obtained ethical approval on the organisational level and oral informed consent on the individual level, patients will receive an anonymous, self-reported questionnaire from their treating physician. They will be asked to fill it in and send it back to the co-ordinating centre.

Data will be entered and analysed centrally by the coordinating centre. The data-base will be made available to all interested study group participants upon request and after approval of the ES V study group.

The following data-analysis procedures will be performed:
a descriptive analysis of the SRH-needs assessed
a bivariate analysis of demographic, psychosocial and HIV disease factors associated with specific outcomes (e.g. sexual risk behavior, unintended pregnancies, desire to have children.)
a multivariate analysis (logistic regression) to predict the selected outcome variables.


Data assessment step 3 : Assessing models of good practice and developing
policy recommendation


On the basis of these needs assessments, client-centered criteria for assessing SRH-services targeting PLWH and their partners will be developed. Using these criteria, we aim at identifying existing models of good practice in Europe in an integrated field of SRH for PLWH and to develop guidelines and policy recommendations built on the assessed evidence-based practices.

The collected information will be disseminated throughout Europe, i.e. beyond the project group, to maximize the transfer of knowledge between member states and to create new learning opportunities.

The project links evidence based knowledge (i.e. assessing the SRH-needs and problems of PLWH in a cross-sectional design) with policy development activities (i.e. developing criteria; collecting models of good practice; issuing guidelines and recommendations). The research builds on the methodology successfully used in previous EUROSUPPORT projects from 1996 - 2004.

 
   
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