Quality improvement as a framework for behavior change interventions in HIV-predisposed communities: a case of adolescent girls and young women in northern Uganda
Conventional approaches to HIV prevention remain the foundation for reducing HIV infections in Uganda, but innovations that demonstrate reduction in risk to infection in vulnerable populations also should be urgently embraced. Over the past two years, ASSIST tested a quality improvement for behavior change model to address barriers to behavioral change among adolescent girls and young women (AGYW) at high risk of HIV infection. The model comprised skills building to improve ability of AGYW to stop risky behavior; setting up and empowering community quality improvement (QI) teams to mobilize community resources to support AGYW to stop risky behavior; and service delivery camps to provide HIV prevention services and commodities to AGYW and other community members.
We recruited and followed a cohort of 409 AGYW at high risk of HIV infection over a two-year period to examine the effect of the QBC model on risky behaviors. High-risk behavior was defined to include transactional sex, having multiple sexual partners, and not using condoms in high-risk sex.
The rollout of the quality improvement for behavior change model resulted in a statistically significant (p <0.05) decline in high-risk behavior among adolescent girls and young women involved in the study. The percentage of AGYW reporting multiple sexual partners reduced from 16.6% at baseline to 3.2% at follow up and the percentage engaged in transactional sex reduced from 13.2 to 3.6%. The proportion of AGYW experiencing sexual and other forms of gender-based violence reduced from 49% at baseline to 19.5% at follow up due to the complementary targeting of parents and partners by QI teams.