Abstract

LBPE35 - Poster Exhibition

Evaluation of Zimbabwe's National Behaviour Change Programme implemented between 2007 and 2011

B. Tambashe¹, R. Buzdugan², C. Watadzaushe³, J. Dirawo³, O. Mundida⁴, A. Copas², G. Woelk³, L. Langhaug², C. Benedikt¹, F. Cowan<sup>2,3

1</sup>UNFPA Zimbabwe, Harare, Zimbabwe, ²University College London, Centre for Sexual Health & HIV Research, London, United Kingdom, ³ZAPP-UZ, University of Zimbabwe, Harare, Zimbabwe, ⁴National AIDS Council of ZImbabwe, Harare, Zimbabwe

Background: The National Behaviour Change Programme (NBCP) has been implemented in Zimbabwe since 2007; initially in 26 districts (phase I) expanded nationally to all districts in 2010 (phase II).
Methods: Representative household bio-behavioral surveys of all 18-24 year olds and a proportion of 25-44 year olds were conducted in 16 districts (8 phase I, 8 phase II districts) in 2007 and 2011. We compared knowledge, attitudes and reported behavior between phase I and phase II districts and between 2007 and 2011, using multivariate logistic or multinomial regression analyses.
Results: There were 4,776 participants at baseline and 10,059 at endline (response rate 79% and 72% respectively). In 2011, 74% of participants reported exposure to programme activities.


[Figure 1]

While programme exposure was higher in phase I than phase II communities, the difference was too small to explore changes as a result of programme exposure. HIV prevalence in 18-24 year old women (proxy for cumulative incidence) had declined equally in both phase I (10.9% declining to 9.1%) and phase II (12.4% declining to 10.6%) communities [AOR 1.02 p=0.983] between 2007-11.

	Baseline	Endline	AOR	p value
Entire sample	n=2033	n=4075
	7.4%	6.8%	0.83	0.058
Male	n=985	n=1959
	2.9%	3.4%	1.31	0.295
Female	n=1048	n=2116
	11.7%	10.0%	0.78	0.024

[HIV prevalence by survey round and gender]

There were significant changes reported between 2007 and 2011 irrespective of programme phase;

	Baseline (n=4796)	Endline (n=10065)	AOR	p value
HIV Knowledge Low (0-2 questions)	18.2	8.2	1.00	<0.001
Medium (3-4 questions)	59.8	56.1	2.09
High (5-6 questions)	22.1	35.7	3.70
Attitudes to HIV index (mean) 0-4	7.4	9.1	1.00	<0.001
5-8	51.2	32.5	0.57
9-12	41.5	58.4	1.26
Men only >=2 Sex partners last 12 months	29.1	24.4	0.48	<0.001
Women only >=2 Sex partners last 12 months	7.4	5.1	0.44	<0.001
Condom use at last sex with all non-regular partners, last 12 months	23.5	39.9	2.36	<0.001

[Changes over time]

HIV knowledge increased, attitudes to HIV and gender were more positive. In addition, reported age at first intercourse among 18-24 year olds had declined, reported number of sexual partners in previous 12 months had declined and the proportion who currently had >2 partners had decreased.


[Figure 2]

Condom use at last sex and with non regular partners had increased.


[Figure 3]

HIV testing had increased as had disclosure of HIV status.
Conclusions: Three quarters of Zimbabweans have been exposed to the NBCP since 2007; coverage is now uniform across the country. Over this period there have been significant increases in knowledge, positive attitudes and norms and reported safer sexual behaviour coupled with a well documented decline in HIV incidence.