Mixed-Methods Evaluation of a Novel Community-Based Support and Education Intervention for Individuals with HIV/AIDS in KwaZulu-Natal, South Africa

Abstract

People living with HIV in Sub-Saharan Africa face significant challenges to access appropriate care. Many in need cannot access available services. Community-based peer support groups have long been recognized as a key psychosocial int6ervention to increase treatment linkage. This study aimed to measure the impact of the structured support group intervention Integrated Access to Care and Treatment (I ACT), as implemented by a small community-based organization, on clients' knowledge, attitudes, and practice regarding HIV/AIDS, including their experiences of stigma, willingness to disclose, and uptake of and adherence to treatment services. This study took place in Okhahlamba Local Municipality, KwaZulu-Natal, South Africa. Study participants were people living with HIV attending I ACT groups. Data collection proceeded in two stages: a quantitative component utilized pre- and post-intervention tests, and a qualitative component involved client interviews focused on participants' perspectives on the I ACT program. The pre/post-test measured changes in HIV knowledge, stigma, disclosure, treatment adherence, and linkage to care. Paired t-tests and McNemar's tests looked for significant changes between pre- and post-intervention. Line by line coding according to an inductive approach was used to identify themes in the interview transcripts. Data from 66 clients were collected for quantitative analysis, and 17 participants were interviewed. Paired t-tests did not detect significant changes in the five outcomes between pre- and post-intervention, though McNemar's tests did suggest a limited effect on HIV knowledge and stigma. Qualitative results indicated a psychosocial benefit as participants connected with their peers, expressed themselves openly, and re-engaged with their communities. However, this study was not designed to measure psychosocial impact, and the results have limited generalizability to men. Nonetheless, this study demonstrated that I ACT can effect psychosocial benefit without requiring intensive financial or human resources, and that it is a powerful complement to clinic-based treatment literacy services.