Suchergebnisse

Male circumcision (MC) prevents HIV acquisition in males, leading to calls for extensive implementation in sub-Saharan Africa. The widespread adoption of male circumcision will require social marketing targeted at various families and family members. The objective of this article is to demonstrate the utility of conjoint analysis in the choice of social marketing strategies tailored to different populations to promote male circumcision in Johannesburg, South Africa. Seven social marketing strategies for MC were identified through open-ended interviews ( n = 25). Preferences were assessed using conjoint analysis, implemented in a cross-sectional survey of randomly selected households. An oversampling strategy ensured balance between Blacks (34%), Coloreds (mixed-race; 32%), and Whites (34%). Respondents randomly received a block of 4 conjoint analysis tasks comparing 2 mutually exclusive and exhaustive subsets of the 7 strategies. Preferences were then evaluated using logistic regression stratified by ethnicity and family member. Whereas all strategies were attractive, television marketing, endorsement by church/school leaders, and a countrywide program were most preferred ( p < .0001). Stratified analyses identified heterogeneity, e.g., only Coloreds valued radio ( p < .0001) and a lasting presence in the community ( p < .0001). Within families, mothers and sons were most concordant for Blacks ( p < .05) and Coloreds ( p < .01), but fathers were most concordant with sons among Whites ( p <.05). Conjoint analysis provides valuable insight into preferences and can be used in the development of social marketing, especially when aimed at promoting behavioral change.

AbstractIntroductionPregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV.MethodsWe enrolled pregnant women recently diagnosed with HIV from 14 primary health clinics during pregnancy and followed them after delivery in Matlosana, South Africa. Best–worst scaling (BWS) was used to determine the women's priorities out of 11 attributes related to preventive therapy in the ante‐ versus postpartum periods. Aggregate BWS scores were calculated based on the frequency with which participants selected each attribute as the best or worst among five options (across multiple choice sets). Individual BWS scores were also calculated and rescaled from 0 (always selected as worst) to 10 (always selected as best), and changes in BWS scores in the ante‐ versus postpartum periods were compared, using a paired t‐test. Factors associated with the changes in BWS scores were examined in multiple linear regressions. Spearman's rho was used to compare the ranking of attributes.ResultsOut of a total of 204 participants, 154 (75.5%) completed the survey in the postpartum at the median 15 (IQR: 11 to 27) weeks after delivery. Trust in healthcare providers was most highly prioritized both in the ante‐ (individual BWS Score = 7.34, SE = 0.13) and postpartum periods (BWS = 7.21 ± 0.11), followed by living a long life (BWS = 6.77 ± 0.09 in the ante‐ vs. BWS = 6.86 ± 0.10 in the postpartum). Prevention for infants' health was more prioritized in the post‐ (BWS = 6.54 ± 0.09) versus antepartum periods (BWS = 6.11 ± 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 ± 0.33, p = 0.001). Difficulty in daily pill‐uptake was significantly more prioritized in the postpartum (BWS = 5.03 ± 0.11) than in the antepartum (BWS = 4.43 ± 0.10) (p < 0.01). Transportation cost and worry about side effects of pills were least prioritized. Overall ranking of attributes was similar in both time periods (spearman's rho = 0.90).ConclusionsComprehensive interventions to build trust in healthcare providers and support adherence may increase uptake of preventive therapy. Counselling needs to emphasize medication benefits for both maternal and infant health among HIV‐positive pregnant women.