| Health workers not known to be living with HIV |
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All individuals meeting inclusion criteria, in all clusters. Final recruited sample size expected to be over 1000 individuals. Includes all ‘CHiPs’ in Arms A and B of the trial; and all Health workers linked to the health facilities in all three arms of the trial involved in the delivery or support of HIV-related services or individuals with whom potential clients may interact in accessing these services. Includes both facility-based and active community-based workers.
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Survey rounds will occur in the first year of PopART delivery, after 1 year and in the final year of the study. The questionnaire is comprised of eight sections. In relation to stigma, a set of 12 harmonized indicators will be asked on a 4-point Likert scale. The data collection tool uses facilitated self-delivery on personal digital assistants and a local research assistant is available to answer participant questions.
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A total sample of 40 HCWs purposively sampled to include each of the three main types of HCWs (CHiPs, facility-based and community-based health workers) and to come from different clusters, genders and age groups. |
All participants in the HCW-survey are asked during the implementation of the first round of the survey whether they are willing to participate further in more in-depth qualitative exploration of their experiences. A sample of this group will be interviewed. In parallel to the second round of the HCW-survey, local research assistants will consent this sub-sample and will interact with them multiple times over the subsequent 24–30 months.
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| Health workers who self-report living with HIV in HCW-survey |
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All individuals meeting inclusion criteria, in all clusters. Final recruited sample size expected to be 100 individuals (dependent on underlying prevalence among participants in HCW-survey and rate of self-disclosure in survey).
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A total sample of 10 HCWs living with HIV purposively sampled to include each of the three main types of HCWs (CHiPs, facility-based and community-based health workers) and to come from different clusters, genders and age groups. |
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| People living in the catchment areas of the intervention clinics not known to be living with HIV and/or not a member of a key population group |
5. Longitudinal ethnography of families living in intervention communities |
A total sample of ∼40 families purposively sampled to include families from each arm of the study. |
Families are identified for follow-up from a longer list of potential families recruited through purposive, door-to-door sampling informed by prior formative research in each cluster.
Data are collected ethnographically, including multiple home contacts for discussions and
in situ
observations over the course of 36 months.
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| 6. Sub-sample of population cohort (end-point evaluation cohort for HPTN 071 trial) |
Simple random sample of enumerated houses. All adult residents aged 18–44 years listed, and one age-eligible resident selected at random who is invited to join the population cohort. A random 20% of all participants at each round will answer questions on HIV-related attitudes relevant to stigma. Final sample size for stigma-related questions will likely be over 10 000 individuals at each survey.
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Questionnaire is undertaken and blood sample is collected and stored for retrospective testing which will include HIV testing and other secondary outcome measures. All cohort members, irrespective of HIV status, will be followed after 1 and 2 years (interim surveys) and 3 years (final survey) to measure HIV incidence and other factors including stigma.
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Four hundred non-acceptors (cases) and 400 acceptors (controls) of home-based HIV testing by CHiPs, during the first and second years of the intervention. Cases and controls from the communities in Arms A and B will be enrolled. Potential participants will be selected at random and approached by CHiP personnel, who will seek verbal consent for follow-up by a research team. The latter will then obtain the formal informed consent for case-control study participation.
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Interviews will be carried out by case-control study teams using standardized questionnaires after the end of the first and second CHiP home-based testing round within a community and will encompass questions about a range of characteristics, opinions and behaviours including sexual and health seeking behaviour, previous HIV testing, as well as stigma and psychosocial questions. Cases and controls will also have separate sections in the questionnaire, to explore reasons for not testing and motivation to test, respectively. In the second year, there will also be sub-group analyses to consider participants who: (1) accepted, tested and were found negative at the first round, (2) refused testing at the first round and (3) were absent at the baseline testing round (away from home or newly moved into community). |
| People living in the catchment areas of the intervention clinics |
8. Longitudinal ethnography of families affected by HIV living in intervention communities |
A total sample of ∼20 families purposively sampled to include families from across each arm of the study. The sample will also purposively including people living with HIV who are early initiators on ART, initiators per national guidelines and not (yet) on ART. Each family will include at least one person who discloses this to the research team (and not necessarily to other member of their family) over the course of the data collection period.
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Families are identified for follow-up from a longer list of potential families recruited through purposive, door-to-door sampling informed by prior formative research in each of the study clusters, and from participants in case-control Studies 1 and 2. Data are collected per ‘5.’ above. Individual interviews with the person(s) living with HIV in each family will be conducted to facilitate these participants’ description of their illness narratives.
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| 9. Sub-sample of population cohort (end-point evaluation cohort for HPTN 071 trial) who self-report living with HIV |
All individuals in the population cohort and health worker survey who self-identify as having previously having had an HIV test that was HIV-positive will be asked a specific set of additional questions focusing on such aspects as treatment access and experiences of stigma and discrimination. HIV prevalence is expected to be 15%. We anticipate over 4000 community members and 100 health workers living with HIV to be interviewed at each round. As for the population cohort and health workers studies, except this component will include only respondents who additionally report are living with HIV.
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Stigma-related questions among this group include 12 items that assess shame, internalized stigma, experienced stigma, experienced discrimination and resilience.
Health workers living with HIV participating in the health care worker survey receive an additional four questions to assess stigma they may have anticipated or experienced as a health care worker living with HIV (
Table 2
).
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| 10. Case-control 2: cross-sectional survey of CHiP clients living with HIV who link to ART within 6 months of referral vs non-linkers |
Four hundred people who do not initiate ‘immediate*’ ART (cases) and 400 people who initiate ‘immediate*’ ART (controls), in Arm A during the first year of the intervention. Cases and controls from the communities in Arm A will be enrolled. Potential participants will be selected at random and approached by CHiP personnel, who will seek verbal consent for follow-up by a research team. The latter will then obtain the formal informed consent for case-control Study 2 participation.
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Standardized questionnaires will encompass sexual and health seeking behaviour, as well as stigma and psychosocial questions. Data collection procedures as per ‘7’ above. |
| People living in the catchment areas of the intervention clinics who are members of key population groups |
11. Longitudinal ethnography of families living in intervention communities in which one or more family member is part of a key population group |
A total sample of ∼20 families purposively sampled to include families with members who are also members of different key population groups. The total sample size will be informed by ongoing data collection, including preliminary analysis of baseline data from the HCW-survey. The researchers will adapt the sampling to focus on those key populations most important to understanding stigma in the context of UTT.
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Families are identified in collaboration with local stakeholders providing services to members of the key population groups through a stakeholder mapping exercise conducted in each cluster. Data are collected per ‘5.’ above. As per ‘8’ above, individual interviews with the person(s) who are also a member of key population group in each family will be conducted.
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