Community-Based Interventions for the Prevention and Management of HIV: A Case Study of Queensland, Australia

This case study explores the effectiveness of community-based nursing interventions on the prevention and management of HIV in Queensland, Australia. It covers the present HIV risk factors among PLHA and recommended community-based intervention approaches. The study uses a qualitative case study design and a sample size of 76 PLHA. The intervention includes workshop seminars that emphasize increasing awareness on HIV prevention, providing vocational skills training, and conducting prevention and awareness campaigns.

Running head: Community-Based Interventions 1
Community-Based Interventions for the Prevention and Management of HIV: A Case Study
of Queensland, Australia.
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Table of Contents
CHAPTER ONE: AIM AND OBJECTIVES........................................................................................3
1.1Aim...............................................................................................................................................3
1.2 Research Objectives.....................................................................................................................3
CHAPTER TWO: BACKGROUND AND RATIONALE....................................................................4
2.1 Introduction.................................................................................................................................4
2.2 Global HIV Epidemiology..........................................................................................................5
2.3 Risk Factors of HIV.....................................................................................................................6
2.3.1 Sexual Behavior Patterns......................................................................................................6
2.3.2 Knowledge and Belief about HIV/AIDS...............................................................................6
2.3.3 Community Based Interventions...........................................................................................7
CHAPTER THREE: PROPOSED ACTION PLAN..............................................................................9
3.1 Study Method..............................................................................................................................9
3.2 Target Population........................................................................................................................9
3.3 Sampling Methods.......................................................................................................................9
3.4 Sample Size and Power...............................................................................................................9
3.5 Intervention...............................................................................................................................10
3.5.1 In-depth Interviews.............................................................................................................11
3.5.2 Field notes..........................................................................................................................12
3.5.3 Case Record........................................................................................................................12
3.6 Data Collection Procedure.........................................................................................................13
3.7 Data Collection Methods...........................................................................................................13
3.7.1 Secondary Data: Literature Review....................................................................................13
3.7.2 Primary Data.......................................................................................................................14
3.8 Ethical Statement.......................................................................................................................14
3.9 Data Analysis.............................................................................................................................15
CHAPTER FOUR: ANTICIPATED OUTCOME AND SIGNIFICANCE.........................................17
4.1 Low cases of HIV/AIDS............................................................................................................17
4.2 Improved Impact on Behavioural Change.................................................................................17
4.3 HIV Risk Factors addressed much better...................................................................................18
4.4 Strategies to Evaluate Outcomes................................................................................................18
CHAPTER FIVE: PROPOSED TIMELINE.......................................................................................19
CHAPTER SIX: BUDGET AND JUSTIFICATION OF BUDGET...............................................21
References...........................................................................................................................................23

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Community-Based Interventions 4
CHAPTER ONE: AIM AND OBJECTIVES
1.1Aim
To ascertain the effectiveness of Community based nursing interventions on the prevention
and, management of HIV
1.2 Research Objectives
1. To ascertain the effectiveness of Community based nursing interventions on the
prevention and management of HIV
2. To ascertain the present HIV risk factors among PLHA in Queensland, Australia

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CHAPTER TWO: BACKGROUND AND RATIONALE
2.1 Introduction
The Human Immunodeficiency virus (HIV) is among the communicable diseases that have
been in existence for long despite the increased focus on it by both scientists and stakeholders
on how to prevent and manage its overwhelming prevalence. It is clear that up to date there is
no specific cure for HIV infection, meaning that the only effective intervention is preventive
and control of the transmission. Current global statistics on HIV indicate that the disease
burden of HIV exists both in developed and developing countries but at different levels
(World Health Organization, 2013). Global statistics show a shift in HIV epidemic over the
last three decades, with approximately 3.7 million new infections in the nineties to the
decrease in the death rate associated with HIV infection in 2000 (UNAIDS, 2013). This
decrease can be attributed to the advancement in treatment approaches such as the
introduction of antiretroviral drugs (ART). It is estimated that 9.7 million people from
developing countries were receiving ART in 2012 (UNAIDS, 2013). Whereas, the use of
ARTs is plausible it has also significantly increased the number of people living with HIV
(PLHIV) to 35.3 million by 2012 (Ambrosioni, Calmy, & Hirschel, 2011). Additionally,
improved access to ART has reduced the mortality rate related to HIV/AIDS in developing
countries by 5.2 million in 2010 (World Health Organization, 2013). The incidences of new
HIV infections has been reported to decrease at a slow pace with the most significant decline
of 52% being reported in children within ten years (UNAIDS, 2013). This unsteady decline
can be attributed to the increased number of PLHIV, increased awareness of HIV infection
and transmission among others. HIV infection does not only affect the victim but the family
and society as well. Studies have indicated that HIV infection leads to stigmatisation, reduced
productivity and increased poverty due to its economic burden on both the individual, family
and the country. This, therefore, calls for the necessity of a community-based intervention for

Community-Based Interventions 6
the prevention and management of HIV. This proposal seeks to explore the prevalence of
HIV worldwide and recommend the most appropriate community-based intervention
approach for the same.
2.2 Global HIV Epidemiology
The incidence of HIV has been studied region wise due to the varying HIV risk factors. In
sub-Sahara Africa the rate of new infections and mortality rates linked to HIV/AIDS is low
according to the UNAIDS (2013) report. Additionally, the report shows that HIV prevalence
had declined by 50% in 2012, but cases of PLthe HIV has also increased by 6 million in 2012
due to the increased accessibility to ART. Subsequently, the death rate due to AIDs-related
sickness has also declined by 1.2 million by 2012. According to the UNAIDS (2013), the
leading cause of HIV infection and transmission is high cases of unprotected heterosexual
conduct.
The HIV prevalence in Asia is second globally after Africa (UNAIDS, 2013). The incidences
of HIV have been on the decline in Asia, but the PLHIV were reported to have increased by 1
million in 2012. Similarly, in 2012 the death rate due to AIDs and associated diseases in
children and adults decreased by 70,000. The accessibility to HIV treatment services in
Asian countries is adequate. However, less than 20% of pregnant mothers received ART. The
NHFPC (2014) indicates that India and China have the highest HIV prevalence with 46.5%
heterosexual intercourse being the common mode of transmission, then substance abuse
(28.4%).
According to the World Health Organization (2011), the prevalence of HIV-related deaths
and new infections in the Middle East and North Africa is on the rise. Incidences of PLHIV
increased by 50% and death rate by 32%. Injection drug use (IDU) and unprotected sex were
found to be common modes of infection and transmission (UNAIDS, 2013). The Caribbean

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and Latin America have low cases of HIV prevalence of and mortality but with over 1 million
cases of PLHIV in 2012 due to better medical services and accessibility to ARTs. The
females account for 60% of PLHIV both in Latin American and the Caribbean, and this
accounts for the highest rate worldwide (UNAIDS, 2013).
2.3 Risk Factors of HIV
Multiple sexual behaviour patterns determine HIV risk infection. Some of these include
2.3.1 Sexual Behavior Patterns
Violence in sexual relationships makes women more susceptible to sexual abuse. A study
conducted by Bromfield (2014) indicated that forced sexual intercourse resulted in the rise of
CD4+ cells in the cervical epithelium which directly exposed the vagina cells to sperms, thus
increasing chances of HIV infection if the semen has HIV. A systematic review was
conducted by Campbell, Lucea, Stockman, and Draughon (2013) on the association between
forced sex and the risk of HIV. The findings indicated that women were more vulnerable to
HIV infection because of their vulnerability to forced sex. Incidences of rape or forced sex
have also been reported to be on the rise thus increasing the likelihood of HIV infection
among the most vulnerable group. The WHO (2017) indicate that 1 out of 3 women have
experienced sexual violence.
2.3.2 Knowledge and Belief about HIV/AIDS
Multiple studies have demonstrated that awareness on the fundamental information on the
infection and transmission of HIV/AIDS has been achieved (Singh & Jain, 2009). However,
there still exists erroneous views on HIV infection. The study by Thanavanh, Harun‐Or‐
Rashid, Kasuya, and Sakamoto (2013) on the knowledge regarding HIV/AIDS among
secondary students found out that as much as there was sufficient knowledge on the how HIV
is transmitted, still there were 59.3% misconceptions on the routes of transmission. Such
erroneous beliefs give people a wrong understanding of the actual risk infection of HIV.

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Studies have found out that inadequate knowledge on the basics of HIV increased its
prevalence in assigned areas (Kharsany et al., 2012).
2.3.3 Community Based Interventions
Community-based intervention (CBI) is defined as the primary care which comprises of
preventive care, e.g. health screening, health awareness against HIV/AIDS in addition to
AIDS treatment at the community level (Minkler & Wallerstein, 2011). Community-based
interventions have been applause as the most effective approach towards the prevention and
control of HIV due to its holistic approach, and the fact that HIV/AIDS has no specific cure.
Through the critical review of the relevant literature on CBI, the following types of CBI were
ascertained.
2.3.3.1 Workshops and Training
The outcomes of the literature review showed that education on HIV prevention offered
through workshop training was the one used in most cases. Stangl, Lloyd, Brady, Holland,
and Baral (2013) conducted a systematic review on the effectiveness of vocational skills
training in addition to income generation interventions on the prevention of HIV and found
out that the provision of microfinance aid did not have any significant effect on HIV
prevention except when integrated with health education. Fonner, Armstrong, Kennedy,
O'Reilly, and Sweat (2014) carried out a meta-analysis on sex education that is school-based
and the prevention of HIV in developing countries. The authors found out that sex education
that is school-based was the most appropriate in minimising HIV risk among students.
Barroso et al. (2014) conducted an RCT on the women of the Deep South to ascertain the
effect of stigma on the prevention of HIV. The participants were supplied with educational
video clips on stigma. The authors found out that the training on stigma was effecting in
minimising the effects of stigma and prevention of HIV. While demonstrating similar
positive outcomes, Harper et al. (2014) conducted a study on youths and adolescents infected

Community-Based Interventions 9
with HIV using group-based interventions comprising of training sessions. The authors
reported a significant reduction in HIV-related stigma.
2.3.3.2 Prevention and Awareness Campaigns
A meta-analysis on the efficacy of HIV prevention using mass media interventions was
conducted by LaCroix, Snyder, Huedo-Medina, and Johnson (2014) and the outcomes of the
authors indicated that the campaign awareness led to the increase in the use of condoms
(25%), knowledge on transmission (30%) and prevention (39%). Thus, the findings were
evidence of the efficacy of campaign awareness on reducing the global prevalence of
HIV/AIDS. Bagali and Makhoahle (2013) examined the effect that awareness campaigns on
the prevention of HIV on university students. All the participants showed that they were
conscious of the correct transmission modes of HIV with 66% consenting to the fact that
unprotected sex and breastfeeding (75%) were the major HIV transmission modes. 93% were
aware that HIV, has no cure. The most common source of information was Television
followed by magazines.

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CHAPTER THREE: PROPOSED ACTION PLAN
3.1 Study Method
This study will adopt a qualitative case study design to ascertain the effectiveness of
community nursing based intervention on HIV prevention and reduction on people living
with HIV/AIDS (PLHA) in Queensland Australia.
3.2 Target Population
The target population will consist of 100 PLHA in Queensland Australia
3.3 Sampling Methods
The researcher will use purposive sampling to identify the study subjects based on the
following inclusion criteria:
 The participants must be HIV positive for at least 24 weeks
 The participants must be 18 years and above
 The participants must be living in Queensland as at the time of the research
 It is mandatory for the participants to be fluent in English
 The participants have to be ready and willing to share their life experiences during
the in-depth interview
 It is mandatory that the participants be willing to consent to the audio recording of
the conversation
3.4 Sample Size and Power
The sample size for the study will be determined using Cronbach's formula as demonstrated
below:

Community-Based Interventions 11
Where; n = the desired sample size
N = the target population and
e= acceptable margin of error estimated at 0.05 (95% C.I)
e2 = (0.05)2 = 0.0025
Therefore, sample size (n) = 100/(1+0.3) = 120/(1.3)
= 76.92
N= 76 (sample population)
3.5 Intervention
A community-based intervention on HIV prevention and reduction will be implemented to a
defined group of residents living with HIV alongside their partners in Queensland Australia.
The intervention will include workshop seminars that will last for four days and emphasize
on the following matters:
 Increasing awareness on HIV prevention and management
 Equipping the PLHA and their associates with required leadership skills to lead
their communities towards the prevention and reduction of HIV
 The community based intervention will comprise of a four day workshop with the
first two days involving trainings and later on the participants will be encouraged to
initiate a project with other cohorts within the community for a period two years.
The remaining two days will be used to assess the effectiveness of the project they
will have implemented and a follow-up made continuously for three years. Six
participants will be trained per session until all of the 76 participants undergo
training. It is estimated that the entire project will last for three years.

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 The workshop training will be structured in a way that it includes processes and
activities aimed at developing knowledge and comprehension of the HIV
prevention and reduction and how to manage it, foster interactive understanding
and trust through contact and sharing. The CBI will employ a participatory method
aimed at promoting participant involvement, association and teamwork. This will
be achieved by utilising multiple participatory activities and objective inputs by the
project facilitators. The facilitators will initially undergo training prior to the
commencement of the project.
3.5.1 In-depth Interviews
Assessment will be carried out at the conclusion of each day of workshop training using in-
depth interviews. All the participants will be granted the opportunity to take part in the
reflection of the day’s activities, and the outcomes gathered as case record. The facilitators
will then under the guidance of an interview schedule with two major open-ended questions
inquire of the experiences of the participants regarding the day’s workshop training. An
example of question will look like
“What was your experience of day one of the workshop?” Why?
“What do you think are the risk factors of HIV?”
The interviews will then be audio recorded. The audio recording machine will be placed at an
ideal place to avoid any distraction of the novice researcher and making the participant
uneasy. For effectiveness in data collection, the researcher will employ various
communication methods such as listening, contemplation, analytical, minimal verbal
interposes, inspiring, recognising and clarifying (Botma, Greeff, Mulaudzi, & Wright, 2010).

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3.5.2 Field notes
Both the co-facilitator and facilitator will take field notes while the workshops are in session
and at the conclusion of the day’s workshop. The field notes will be structured in such a way
that they cover all the primary elements of the training. Therefore the field notes will contain
sections on observational notes, methodology notes and individual notes. Yin (2017)
indicates that the preparation and use of field notes should focus on the primary tasks in data
collection such as:
 Acquiring access to the significant organisations or interviewsEnsuring that there is
adequate resource while in the field. This comprises of a personal computer,
writing materials, paper clips, and serene writing environment.
 Designing a protocol for calling for aid and directions, when necessary, from other
facilitators in other case studies
 Outlining the unambiguous procedure for gathering data tasks that should be
completed within a pre-determined time
 Making provisions for unexpected happenings such as the absence of the required
number of interviewees, in addition to the variations in the mood and impulses of
the researcher Yin, 2017)
3.5.3 Case Record
The case record will consist of an in-depth account of the intervention on HIV prevention and
reduction, presentations and the interventions guide, and the views of the respondents after
the conclusion of each day’s intervention. Additionally, the case record will include the field
notes of the investigator while the intervention was in force, an in-depth account of the
project of the study group and the assessment report.

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3.6 Data Collection Procedure
Community access will be gained by using the local administration alongside Non-
Governmental Organizations (NGOs) who have also gained trust in the community.
Moreover, field workers will be utilised in linking the investigators to the potential
respondents. Based on the nature of the CBI, the venue should be free of distractions and
private. Thus the Queensland community social hall will be used. However, private rooms at
the homes of the participants will also be used in cases where the participants would prefer
so. The researcher assistant will at the first encounter with the potential participants explain
the aim of the study and ensure that they are aware of their role in the research and the nature
of data to be gathered. Free transportation to and from the venue will be provided to the
participants in addition to meals and refreshments in the course of the intervention. The
researchers will give the autonomy to pull out from the study at any time (Botma et al.,
2010). The audio recording will be used to collect data during interviews.
3.7 Data Collection Methods
3.7.1 Secondary Data: Literature Review
The scope of the literature review section of this study focused on the studies conducted in
the prevention and management of HIV using community-based nursing interventions. The
research articles included in the analysis had first to be based on community-based
interventions the prevention and control of HIV/AIDS, and secondly, the researches must
have been published within ten years. The articles included in the study were based on both
CBI in developing and developed countries in order to obtain comprehensive insight into the
study topic. The key terms used in the search included community based intervention, HIV,
AIDS, HIV risk factors. A total of 1000 published articles were searched using search
engines and databases such as Google Scholar, PubMed, BMC, and NCBI. The researcher
then screened the topics and abstracts and 200 full texts were found. A further qualitative

Community-Based Interventions 15
check led to the inclusion of 19varticles for critical review. The findings from the literature
view were presented under different themes as shown in the literature section in this paper.
3.7.2 Primary Data
3.7.2.1 In-depth Interviews
In-depth interviews will be conducted on the possible risk factors of HIV and the
effectiveness of the workshop training. The workshop facilitators will also be used as
interviewers after undergoing short-term training on how to conduct in-depth training.
Seidman (2013) asserts that in-depth interviews provides detailed information because the
interviewee can probe for more information from the interviewee. Audio recording will be
used to collect data during the interviews. The researcher chose audio recording because it
ensures that quality data is recorded since the actual responses of the feedback are used for
analysis (Evans & Jones, 2011).
3.7.2.2 Field notes
Field notes are a written reflection of the events that the researcher observes, ears, perceives
and thinks when the interview is underway (Botma et al., 2010). Field notes will be noted
down while the workshop training is ongoing and immediately after the interview.
3.8 Ethical Statement
Institutional ethical approval is to be obtained before the commencement of the study.
Informed consent will be obtained from the prospective participants before the study (Felt,
Bister, Strassnig, & Wagner, 2009). All the participants will be provided with the details of
the research such as the objectives of the study, the nature of data to be collected and the
purpose of the data to be collected. The researcher will also endeavour to assure the
participant that the received data will only be used for the disclosed purposes. The
participants will be given specific identification codes that will be used throughout the study.
This will ensure that their specific identifies such as names are hidden.

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3.9 Data Analysis
The researcher will analyse each case independently and then compiled. Different elements
of the case record will be ascertained. Document analysis and pattern matching will be used
to investigate the case record. Bowen (2009) observes that document analysis reduces
researcher biases due to the stability of the documents which are unreactive and can be
assessed severally without making any changes by the researcher.
The data obtained through tape recording will be transcribed and analysed using the
guidelines recommended by Creswell and Creswell (2017). These include
 The researcher will first obtain a view of the entire thing by meticulously going
through the transcriptions and noting down some thoughts that cross the mind
 Then one interview transcript will be picked and then perused with a view of
understanding the meaning without going through the content. Similarly, important
points are noted down
 The researcher will then go through multiple transcripts of data while incorporating
the details in the second step. All the topics that come up are noted down in
columns
 Using the generated list of topics, the researcher will again go back to the data and
abridge the topics as codes and near to the correct parts of the text. Then the
emergence of new categories and codes will be observed
 The researcher will then look for the best descriptive wording for the topics and
change them into groups. then the categories that are similar will be grouped and
any inter-associations noted
 A final verdict on the acronym is made for each class, and then the codes are given
alphabet names

Community-Based Interventions 17
 Then the data in each category will be gathered together, and a preliminary
assessment carried out
 If need be the current data can be recorded (Botma et al., 2010)
The data will be analysed by an independent researcher not involved in the study. The
independent researcher for coding will be informed of the objective of the research in
addition to the recommended procedures for data analysis. The coding of categories and the
emergent themes will be discussed, and an agreement arrived

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CHAPTER FOUR: ANTICIPATED OUTCOME AND SIGNIFICANCE
4.1 Low cases of HIV/AIDS
There are expected low cases of HIV/AIDS prevalence in the selected towns because the
training will address on the prevention and management of HIV under topics such as condom
use, voluntary counselling, HIV infection and transmission modes. Studies have shown that
the implementation of interventions aimed at preventing and managing HIV/AIDS when
implemented in the community settings led to the reduction in the spread of HIV. Rhodes,
Malow, and Jolly (2010) carried out a study on the efficacy of community-based participatory
research on the prevention and management of HIV/AIDS. The findings of the authors
indicated that the incidences of HIV/AIDS reduced once a CBI was successfully
implemented because this approach ensures that the affected community is involved in
decision making and in ascertaining priorities leading to the development of interventions
that are aimed at meeting the needs of the community.
Sweat et al. (2011) also carried out a randomised CBI in three developing countries to
ascertain the impact of increasing HIV testing on the prevention of HIV/AIDS. The authors
found out that a greater percentage of participants were tested in the CBI than in the control
group. Salam, Haroon, Ahmed, Das, and Bhutta (2014) reviewed the impact of CBI on HIV
awareness, perceptions and transmission and indicated that CBI was more efficacious in the
prevention and control of HIV.
4.2 Improved Impact on Behavioural Change
It is likely that the proposed CBI will positively influence positive behaviour change among
community residents because it will increase awareness on the modes of transmission and
techniques. Coates et al. (2014) ascertained that voluntary involvement in CBI led to changes
in social behaviours which are directly linked to the infection and transmission of HIV.

Community-Based Interventions 19
4.3 HIV Risk Factors addressed much better
The intervention will only focus on PLHA and thus the relevant HIV risk factors in
Queensland will be determined and the prospective control measures recommended. Studies
have pointed out that the control of HIV risk factors will lead to the prevention and spread of
HIV. Miller, Hellard, Bowden, Bharadwaj, and Aitken (2009) undertook a study on the HIV,
HCV risk factors in Melbourne and showed that addressing the risk factors was the most
effective approach in reducing the prevalence of the diseases.
4.4 Strategies to Evaluate Outcomes
The strategies to evaluate the outcomes of the CBI to be implemented in Queensland on the
management and prevention of HIV will be based on the expected results. The following
strategies will be used:
 Reduction in HIV prevalence in Queensland. The number of HIV cases after and
before evaluation will be assessed to ascertain the impact and outcomes of the CBI.
 Improvement in behavioural change. Since the objective of the CBI is to prevent and
manage HIV through workshop trainings, the outcomes will be evaluated based on the
behaviours that promote HIV. For instance, the level of prostitution, drug abuse
through injection will be assessed to ascertain the outcomes of implementing the CBI.
 The awareness level of HIV risk factors among the participants can be used as an
evaluation strategy to determine the outcomes at the end of the training period.

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CHAPTER FIVE: PROPOSED TIMELINE

Community-Based Interventions 21
Year 1 Year 2 Year 3
Activities
QTR
1
QTR
2
QTR
3
QTR
4
QTR
1
QTR
2
QTR
3
QTR
4
QTR
1
QTR
2
QTR
3
QTR
4
Determining research problem
Ascertaining Research objectives
Literature analysis
MOU with the local administration
Training of workshop facilitators and
research assistant
Ascertaining Data collection method
Design of data collection tools: In-depth
interview schedule,
Structuring the project proposal
Calculation of sample size and power
Data collection
Data analysis
Drafting
Actual reports

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CHAPTER SIX: BUDGET AND JUSTIFICATION OF BUDGET
The overall total budget for the study has been estimated to cost $ 470 for all the three years
with year one a more substantial amount ($200), second year ($150), and final year ($120).
The expenses for the years decrease due to the decline in the study activities as will be
justified herein. The study will require the services of two project facilitators to aid in
delivering training services to the 76 potential participants. Since these will be novice
facilitators they will be paid 50 dollars in the first year and 40 dollars in the second year.
Their services will only be required in the first two years only since the third year will
comprise of follow-ups on the study and shall be conducted by the researcher and research
assistant. Similarly, the transportation of all the personnel namely, the lead investigator,
research assistant, and two facilitators will cost approximately ten dollars per year. Designing
and printing of interview schedule are estimated to cost fifty dollars because an expert will be
hired to assess the schedule designed by the lead researcher. The community social hall shall
not be paid for since it had been confirmed that the community would not charge us since the
project is to benefit the community.
An independent coding expert shall be hired at the cost of 20 dollars during data analysis to
avoid researcher bias and increase the credibility and reliability of the study. A government
bus shall be used to transport the potential participants at the cost of 120 dollars during the
entire period of study, after prior arrangements with the Local area government of
Queensland. This move will ensure that the expenses are subsidised.

Community-Based Interventions 23
Year 1 Year 2 Year 3
Amount ($)
Personnel
Project Facilitators 2- ($10/hr) 50 40
Research Assistant 1 ($14/hr) 30
Cording expert 20
Sub-total 80 40 20
Project Support
Transportation expenses for all personnel 10 10 10
Transportation expenses for all participants 30 40 40
Data collection equipment and materials:
Designing and printing of interview schedule 50
Hiring audio recording equipment 10
Meals and refreshments for all participants 40 60
Sub-total 90 110 100
Project Activities
Access fees for literature review 30
Hiring of community social hall
Sub-total 30 0 0
Total/Year 200 150 120
Overall Total $470

Community-Based Interventions 24
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