Qualitative evaluation of a large "test and treat" trial: Characterizing baseline community contexts and implementation processes in SEARCH
A key challenge of large-scale intervention trials is to adequately describe the social, cultural and operational factors that influence study findings. Qualitative research methods are particularly useful for elucidating the processes through which such trials may affect primary clinical outcomes through social and behavioral change at the community level. This pilot award would launch the qualitative evaluation of a large "test and treat" intervention, the Sustainable East Africa Research in Community Health (SEARCH) trial. SEARCH is a 5-year study to test the effectiveness of annual Community Health Campaigns (CHCs), and streamlined ART for HIV-infected individuals independent of CD4 count, in reducing community HIV incidence in Kenya and Uganda. We propose to use a set of rigorous qualitative research methods to assess how the SEARCH trial affects community social norms, beliefs, practices and discourses, and to document the trial?s diverse implementation contexts and processes. Our study will be conducted in 8 matched intervention and control communities, to achieve the following specific aims: Aim 1: Describe baseline experiences, attitudes, and challenges in providing HIV/AIDS care, including expanded ART, using in-depth interviews with 40 healthcare providers. Aim 2: Characterize baseline social norms, beliefs and practices related to HIV testing and disclosure; perceived HIV stigma and experiences of stigma; sexual risk behaviors, and use of ART and other medical services, using in-depth interviews with 80 community members. Aim 3: Describe the nature of and variability in implementation of community mobilization processes and health campaigns in SEARCH (using participant observation at CHCs, focus group discussions with trial participants, and in-depth interviews with leaders in the 8 communities).