An effective preventative HIV vaccine could be an important prevention tool for high-risk communities in India such as men who have sex with men (MSM) and transgendered individuals (TG). To ensure any prevention technology will be effective, it must be tested in those that will benefit from it most. In order to recruit MSM/TG participants in research, it is important to know about their accessibility and sexual risk behavior for which little information exits. This formative research study, conducted in collaboration with the Population Council, sought to better understand the group dynamics, sexual risk profiles and health care-seeking patterns of the MSM/TG populations to better inform future cohort development for HIV prevention research. With some variation among research sites, results revealed that multiple factors increase MSM/TG’s vulnerability to HIV infection. Strong social networks (MSM), membership in organized community households (TG) and a high awareness of and access to HIV prevention services indicate potential opportunities for outreach and information about AIDS preventive research studies. To engage MSM and TG communities in HIV prevention research initiatives, it will be essential to work with peers and NGO’s (MSM) and gurus and CBO’s (TG).

 

 

This qualitative study was initiated to better understand policy makers’ and other influentials’ views on the potential introduction of HPV vaccines in Tamil Nadu. With the goal of providing guidance for an informed and effective public-sector HPV vaccine-introduction strategy in Tamil Nadu, issues critical to the introduction of a new vaccine targeting adolescents, information required to make a decision about introducing the vaccine and recommendations for introduction were explored. This study suggests that policy makers will need additional information to make an informed decision regarding HPV vaccination including data on prevalence and the socio-economic burden related to cervical cancer as well as the safety and efficacy of the vaccine. They will also need to understand the link between HPV and cervical cancer, alternative means of preventing cervical cancer, why the vaccine would be a critical complementary method of prevention and the impact of the vaccine on the current and future health of girls. Understanding the information needs of policy-makers and other influentials is one piece of a puzzle of information required to inform decisions and develop introduction programs for new vaccines and other health technologies.

 

 

Quality Improvement (QI) has been widely implemented in health services but has not been widely applied in HIV prevention research. Most prevention research centers have commonly employed traditional approaches (e.g. checklists) to quality control that document what has been done but not the quality of what has been done. Unlike other health settings, prevention research settings have unique characteristics and ethical requirements that require the development or adaptation of specific quality indicators. A QI model for health services was adapted for use in prevention research settings and piloted at 3 research centers in East Africa. On average, 52% of total enrolled volunteers participated in the exit interview. The designed QI plans successfully helped reduce volunteers’ reported waiting time to see counselors and pharmacists. It also increased the percentage of interviewed volunteers who reported being counseled on family planning at clinical trials (from 66% to 93%) at follow-up visits, and who were refreshed on informed consent at follow-up visits (from 90% to 96%). The percentage of interviewed volunteers that expressed satisfaction with services received from counselors increased (from 87% to 94%) while the percentage of volunteer satisfied with services from trial physicians remained constant (93%). The majority of volunteers interviewed reported satisfaction with other major components of research such as confidentiality, understanding of trial objectives, benefits and risks of participation and risk reduction counseling. However, satisfaction with services from community outreach workers and other staff at research centers dropped over the course of the study (from 88% in cycle 1 to 74% in cycle 3). See article published in AIDS Care http://www.tandfonline.com/doi/abs/10.1080/09540120903012569

 

 

Promising HIV vaccine products must be tried in appropriate populations if their efficacy is to be known, thus there is a need to identify and prepare different populations, as well as to learn more about targeting mobile and difficult to reach groups, for future large scale vaccine trials. Fisherfolk comprise an important population considered at risk to HIV in Uganda and elsewhere in developing countries. This study sought to better understand the social and behavioral factors that might put fishing communities at risk for HIV infection including occupation, mobility patterns, sexual and social networks and sexual activity, and to identify factors that promote or hinder uptake of VCT, HIV treatment and care and HIV research. Findings suggest that HIV/AIDS is a significant problem in these fishing communities, and that while prevention services are limited, there was great demand and response for VCT services. Despite challenges, a conclusion can be drawn that these communities are suitable for an HIV vaccine trial.