ASSESSMENT OF HIV PREVALENCE AND RISK
BEHAVIOURS
AMONG THE PRISON POPULATION IN ZIMBABWE;
Adoption of the UNODC situation and needs assessment
toolkit for the Zimbabwe situation
Dr. P. D. Parirenyatwa
Executive Director
Centre for Health Strategies
11a Lincoln Rd, Avondale
Harare, Zimbabwe.
E-mail; [email protected]
Study Objectives
• To estimate the prevalence of HIV among prison inmates and
define risk behaviors associated with HIV transmission
• To provide baseline information to inform policy, advocacy and
refinement to national strategies as well as program planning
for the prison population
• To determine availability and accessibility of services for HIV
and AIDS prevention, care and treatment in prison settings and
document service delivery gaps for comprehensive HIV and
AIDS prevention, care and treatment
• To make recommendations for a comprehensive action plan on
HIV and AIDS prevention, care and treatment in the prison
settings
Step 1:Multi-sectoral Approach
UNODC Toolkit
• Establish a national
steering committee
• P.I. To recruit
research team
ZIM Situation
• Multi-disciplinary
steering committee ;
– Zimbabwe Republic Police; Drug
unit
– Zimbabwe Prison Service
– Ministry of Health and Child
Welfare: AIDS and TB Unit
– National AIDS Council
– W.H.O
– UNFPA
– UNODC
• Thorough selection and
vetting of research
assistants
Step 2:Development of Protocol
UNODC Toolkit
• Consult W.H.O,
National Ethics body,
Prison Ethics body on
ethical
considerations.
• Obtain approval of
protocol from steering
committee
ZIM Situation
• Consulted W. H. O
ethical requirements and
more importantly
Zimbabwean National
Ethics guidelines.
• Presented protocol to
steering committee
through a consultative
full day workshop.
Step 3: National Ethics Committee Approval
UNODC Toolkit
• Apply to national
ethics committee
ZIM Situation
• Obtained approval
from Medical
Research Council of
Zimbabwe (MRCZ)
and the Zimbabwe
Prison Service Ethics
Board (ZPSEB)
Step 4: Train Assessment Team, collect and
analyse available information (secondary data)
UNODC Toolkit
ZIM Situation
• Four day training session of
• Train assessment
research assistants;
team on
– Logistician
–
–
–
–
–
Overview of objectives
Interviewing techniques
Field procedures
Questionnaire description
Confidentiality agreement forms
• Collect secondary
data
–
–
–
Field supervisors
Interviewers
Laboratory technicians
• Training content;
– Administering interviewer guided
questionnaires
– Conducting FGDs
– Questionnaire description
– Ethical conduct
– Serial HIV testing using Rapid HIV
test Kits
– Confidentiality agreement forms
• Mainly primary data as there is
lack of secondary data
Step 5: Collect and analyse the national framework
and prison conditions
UNODC Toolkit
• Data collection and
analysis of the
national framework
and prison conditions
from ZPS and
relevant ministries
ZIM Situation
• Obtained secondary
information from
– ZPS; data paucity
– Ministry of Justice and
Legal Affairs however it
was not comprehensive.
– Ministry of Health and Child
Welfare did not have
anything.
Step 6: Qualitative data collection; Interview staff
and prisoners
UNODC Toolkit
ZIM Situation
administered questionnaires
• Interview prison staff • Interviewer
for both staff and inmates;
– Administered staff questionnaires to all
and prison inmates
seven levels of prison staff including
health personnel
• Conduct FGDs
• All inmates who responded to
• Key Informant
questionnaires were also tested so as to
link results with responses (Anonymous
Interviews
•
•
testing)
FGDs conducted to inmates in groups of
15 to 20 (at least two discussions at
each sampled prison site)
Key Informant Interviews;
– Permanent Secretary of Ministry of
Justice and Legal Affairs
– Director Ministry of Health and Child
Welfare; AIDS and TB unit
– NAC Chief Executive Officer, etc
Step 7 a): Cross sectional anonymous survey on
risk behaviour
ZIM Situation
UNODC Toolkit
• Field preparation; Sensitised ZPS
• Field preparation
• Questionnaires;
– Should be self
administered or face to
face interviews in the case
of illiterate inmates
– Localised languages
– Frequently used prison
terminology
• Pre-testing
and respective sampled prison sites
through letters and visits.
• Adapted questionnaires
– Administration of all questionnaires
was interviewer guided-for
completion and to cater for illiterate
inmates
– Used common prison language
and terminology.
– Translated questionnaires from
English to Shona and Ndebele.
• Pre-testing was done at a
selected prison site; Kadoma
prison
Step 7 a): Cross sectional anonymous survey on
risk behaviour (2)
•
UNODC Toolkit
Sampling;
–
ZIM Situation
• Sampling;
Sample should be sufficiently large to yield
an acceptable degree of precision
(confidence interval of 95%) and sample
should represent the full study population.
– sampling frame used was a list (obtained from
ZPS headquarters) of all prisons and numbers of
inmates (both sexes) nationwide.
– Cochrane formulae used to calculate sample size.
Employed multistage sampling with the following
characteristics;
– Stratified by males and females and collected
adequate samples to ensure at least 5% margin of
error and 95% confidence level for both
– Clustered by prisons and visited all four regions
– Calculated samples for males and females
independently using probability proportional to
sample size (PPS) for each prison site.
– Ensured that each inmate had equal probability of
being selected;
• Simple random sampling used to select
participants; picked numbers from a hat and
then they were called out until sample target
was achieved.
Step 7 a): Cross sectional anonymous survey on
risk behaviour (2)
ZIM Situation
UNODC Toolkit
• Inclusion criteria
• Inclusion criteria
– Inmates > 3 months stay in prison
– > 18 years of age
• Recruitment of
– All 46 prisons in the country
prisoners
• Recruitment of prisoners:
– All inmates assembled at one place
• Keeping data
and informed of the study aims and
anonymous;
benefits.
– Barcode labelling
– Simple numbering system
– All willing participants had further
explanations of the study and signed
informed consent forms.
– No incentives as this is against
national rules and regulations.
• Keeping data anonymous;
– No names were used at any point,
instead numbers were used.
•
Step 7 b): Cross sectional anonymous survey on
risk behaviour
UNODC Toolkit
ZIM Situation
• HIV testing
• HIV testing
methodology;
methodology; Used
rapid test kits in
– ELISA
accordance with the
– Western Blot
national serial HIV
– Rapid Test Kits
testing protocols.
– First used Determine
– Then used SD Bioline to
confirm any HIV positive
results
– Used Insti to decide if the
two above did not agree.
Step 8: Analyse and interpret data
UNODC Toolkit
• Understand the trend and
impact of HIV and AIDS
in the prison system
• Determine the
characteristics of HIVinfected persons and
persons engaged in high
risk behaviours
ZIM Situation
• Analysis was done using
the Statistical Package
for Social Sciences
(SPSS version 17.0)
• Relationships between
variables were identified
using cross tabulations,
frequencies and Chi
Square Tests e.g.
– Length of stay of prisoners
and risk behaviours
– Risk behaviour versus HIV
positive inmates
Step 9: Prepare final report
UNODC Toolkit
• Should answer the
objectives
ZIM Situation
• Deliverables include
– Estimated HIV prevalence
– Findings regarding
availability and accessibility
of HIV services in prison,
as well as common risk
behaviors.
– Recommendations
– Proposed action plan
Step 10: Focus Interventions
UNODC Toolkit
• Results of the
assessment should allow
for tailoring the response
to the situation and
needs.
ZIM Situation
• It is our hope that this
needs assessment will
indeed guide future
interventions regarding
HIV and AIDS in prison
Zimbabwean settings.
NDATENDA!