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Testing an Intervention Designed by Female Adolescents and Young Women for Themselves – TuWashindi Study

According to Joyce Boke, the Study Coordinator, TuWashindi study is a youth-designed, multi-level intervention, randomized control study that will look at relationship-focused intervention to reduce gender-based violence and increase Pre-Exposure Prophylaxis (PrEP) uptake among Kenyan adolescents and young women. The study will be conducted in Siaya County by Impact Research and Development Organization (IRDO).
The five-year project targets adolescents and young women aged 15 to 24 years from Siaya County, who are on PrEP and those who are interested in it. During the interview, the Coordinator said the study will be conducted in 22 wards. The target population will be divided into control and intervention arms. The participants randomized into the control arm will receive the standard or usual care for HIV prevention.
Those in the intervention arm will receive the TuWashindi intervention as well as the standard or usual care of HIV prevention services. To enable this, the Ministry of Health (MoH) and other organizations offering HIV prevention services will be engaged. She said the study, which has been funded by the National Institute of Health (NIH) and collaborates with the Research Triangle Institute (RTI), will hopefully be rolled out in August. “Currently we have been doing the preparatory activities and hopefully by mid-August, after the elections, we will roll out the study.” They anticipate enrolling 1,584 adolescents and young women in the intervention.
Joyce narrated the intervention was prompted by the high prevalence of HIV/AIDS in Siaya County, more so in young women. The uptake of PrEP has been low with the presence of the intervention within the community. The pilot study revealed that young women and girls in that community are usually beaten by their male partners when they disclose they are taking PrEP. There are a lot of issues around PrEP uptake and Intimate Partner Violence (IPV).

The study Coordinator proudly narrated that they are well prepared to roll out the study. They have
obtained approvals from Maseno University Ethics Review Committee (MUERC). The protocol training
has been done, staff have been hired and trained, stakeholders engagement meetings have been held,
and mapping to know which wards they will work has been completed. Their next step is community
entry to identify gatekeepers and conduct outreach services in preparations for the enrollment exercise.
The community mapping exercise will involve meeting stakeholders in the community and in the health
facilities where they will recruit some of the potential study participants. It will also involve identifying resources within the community. “With stakeholders in the community, we are looking at having meetings with the chiefs, ward administrators, and community members where we do study sensitization that Impact Research and Development Organization (IRDO) will be conducting this new study within your community, and this is the outline of the procedures that we will be doing.” During the interview, the coordinator said since they will be targeting girls who are already initiated on prep, they will also need data from the facility. The mapping exercise will enable them to obtain the buy- from the facilities to know their mission and also get their support for the project. “Our participant will not be in a controlled setup facility; we will be doing our recruitment in the community.” She said. After outreach activities for sensitization, the recruited participants will be enrolled in the study. During the intervention, they will have support clubs, community sensitization for men, and buddy days. This will involve the utilization of community resources such as schools, churches, halls, football pitches, and beaches. So we are also looking at resources within the community. If you’re having a support club, will the girls be meeting in schools, or will they be meeting in churches?

“ So we need to plan that ahead. As you go to the community to identify which school, which halls are there, and then also for the buddy day, and community sensitization, just to get to know where the men meet. And these men, we are talking about partners of these young girls. So we also want to sensitize them about PrEP. And with that, we need to know if they meet on beaches, around the beaches, on football pitches, or in video games. So knowing those areas within the community will be really key before we start study activities.” The Coordinator explained. She agreed that they have had challenges that they have however managed to overcome. She said they have had a lot of engagement within a very short period. “We’ve had strong leadership and teamwork and we’ve been able to overcome those challenges.” She said. The coordinator said it will not be very easy recruiting young girls and women. “For any project, you will have challenges but I think we will be learning those lessons as we go by,” she said. She continued to narrate saying they are going to operate in DREAMS space which was previously kind of perfect. Again, according to her, many studies that have been done around PrEP and young girls have had challenges with getting the young girls for enrollment. “So it will not be easy, but in a way, we have kind of spread out the study. We do it in a phased manner because we are working in 22 wards.”
According to the Study Coordinator, this study has three objectives. First, it will test the effectiveness of this intervention in increasing the uptake of PrEP among adolescents and young women. Secondly, it will test the effectiveness of the intervention in reducing Intimate Partner Violence (IPV) among young women and girls. Overall, the objective of TuWashindi intervention will be to do a process evaluation to see a change in the mechanism. This entails change at the individual level, partner level, and community level.
To address issues arising from the community, the study has a Community Advisory Board (CAB) and a Youth Advisory Board (YAB) in place. The Coordinator said the groups have been sensitized to act as a bridge between the project and the community. The CAB for instance constitutes teachers, policemen, the MOH staff, religious people, ward administrators, chiefs, and CHVs. The YAB will be able to voice issues among the youth in the community.
In conclusion, the Coordinator said they are really excited and are looking forward to seeing where the study heads. She appreciated the leadership at RTI and IRDO. She also appreciated the teamwork from the staff on the site and is looking forward to being TuWashindi (Swahili word for winners) with PrEP.

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