Newswise — Medical College of Wisconsin researchers, led by Jeffrey Kelly, Ph.D., have shown that, given the right kind of support, an AIDS prevention program found effective in the scientific arena can be successfully transferred to service providers in developing countries. The program focuses on using popular leaders in a community to educate others about how to avoid the disease. The study is published in the September 24 issue of Science.
"Our findings show that advanced communication technologies can link service providers worldwide with training, technical assistance, and consultation in how to use new approaches originating in the research arena," Dr. Kelly says. Dr. Kelly is director of the Medical College's federally designated Center for AIDS Intervention Research (CAIR).
Just giving providers printed materials about new scientific advances isn't enough, the study found. Much better results were gained when service providers gained skills for carrying out the new HIV prevention approach through a combination of interactive distance learning technology plus one-on-one consultative support.
The study built on an earlier Medical College study which demonstrated that high-risk behavior could be reduced in a community when popular and well-liked members of that community (called "POLs" for Popular Opinion Leaders) were trained to introduce AIDS prevention endorsements into everyday conversations with their peers. Because of its established scientific effectiveness, this model was chosen for dissemination.
According to Ellen Stover, Ph.D., director of the Division of Mental Disorders, Behavioral Research, and AIDS at the National Institute of Mental Health (NIMH), "Dr. Kelly's findings open the door for disseminating research results worldwide that can make a difference to the global AIDS community. Our goal in funding this research is to go beyond publishing the results in a scientific journal; it is to help communities put the results of research to good use." The study was funded by a grant from NIMH.
Service providers in developing countries with catastrophic AIDS epidemics have very little access to journal articles and HIV prevention research advances. Dr. Kelly and his team wondered if there was a way to get practical information about the latest developments in HIV prevention science to service providers that went beyond just sending copies of journal articles. The researchers were aware of the power of distance learning techniques using computers and CD-based interactive programs in teaching people from remote locations. Could that technology be adapted to bring advances in AIDS prevention science directly to service providers in remote countries that face the greatest disease epidemics in the world? The positive findings appear to be very encouraging, Dr. Kelly points out.
"We chose the Popular Opinion Leader model for dissemination because it is adaptable across cultures and draws on the power of a community to protect itself from AIDS, and because service providers told us they wanted to be able to offer this approach in their own countries," Dr. Kelly explains. "The practical question we studied is how to efficiently reach thousands of AIDS service providers worldwide with training in new prevention approaches."
Dr. Kelly and his research team selected a group of leading non-governmental organizations (NGOs) working in AIDS prevention in 78 countries in Africa, countries of the former Soviet Union in Eastern Europe, and Central Asia, and Latin America and Caribbean countries. NGOs were divided into two groups: the experimental group and the control group.
The directors of the NGOs in the control group attended an orientation meeting that provided information about the new science-based AIDS prevention method and were given a computer, Internet service, access to a study website in which they could network with other NGOs, and briefing papers on grant writing, program evaluation, needs assessment and organizational management.
Directors in the experimental group received the same supports plus a self-paced curriculum on CD that trained NGO staff in how to implement the POL program. The curriculum described key intervention procedures, modeled techniques and used discussion points through multimedia print, video, and animation techniques. In addition, each NGO was paired with a behavioral science consultant from the Medical College staff who was from that region of the world or who was very familiar with the culture. The distance consultants helped the NGO to adapt and tailor the model to meet its own circumstances. The curriculum was produced in English, Spanish, Russian, and French, the languages used in these regions. It took most NGOs about three to four weeks to complete the curriculum.
In-depth follow-up telephone interviews were conducted with both control and experimental group organizations 15 months later. The researchers found that 43 percent of NGOs that received the distance training had developed new AIDS prevention programs based on the model; only 17 percent of the control groups had done so. Fifty-five percent of the experimental group AIDS service providers incorporated the POL intervention into existing programs vs. 27 percent of control group organizations.
Experimental group NGOs also functioned as "nodes" and networked with other in-country service providers to share the information on the new intervention; 55 percent of them gave copies of the CD or print curriculum to other providers. The new prevention approach was incorporated into official government AIDS prevention programs in 26 percent of the experimental groups' countries.
The research team also found that most of the NGOs did not adopt the POL intervention program in its entirety, but selected elements of the approach. This showed that AIDS service providers adapted the intervention to meet their own countries' needs and cultures, and fit it within their often-limited budgets.
"To stop a global epidemic like AIDS, it is critical that we rapidly and efficiently move scientific advances directly into the hands of frontline service providers in regions hardest-hit by the disease. Our findings show that distance communication technologies can link providers—even in remote developing countries—to training in new models so they can benefit from the latest research," Dr. Kelly says.
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