INSTRUCT Fieldwork Underway in Botswana

The five-year INSTRUCT cluster randomised trial began in January 2014 in Botswana in five randomly selected trial districts, among the 30 districts in the country.

INSTRUCT is an HIV prevention initiative in Botswana that tests the impact of a combined package ofstructural and behavioural interventions focused on young women and the choice disabled.  During 2014, the intervention package is being implemented in a pilot district, accompanied by a strong program of implementation research to examine access to and experience of government structural support programs and to learn how best to implement the intervention package in subsequent districts.

A CIET fieldworker collects data with a tablet.

An initial survey visited all households (as far as possible) to identify young women aged 15-29 years, to collect information about their experience of the structural support programs, and to share user-friendly information about the programs with them. Young women fieldworkers from the district used android tablets to record interview responses and share video clips about the available programs. Workshops for young women will link them to structural programs and build skills in communication and negotiation as well as basic business skills. The intervention package also includes building an enabling community environment by discussing an eight episode audio-drama (about gender, gender violence, choice-disability, and HIV risk) with all segments of the community.

From 2015, the intervention will be rolled out to all five intervention districts, of 30 in the country. A survey in year 4 (2017) will measure the impact of INSTRUCT. The primary outcome measure is HIV sero-prevalence among women aged 15-29 years living in the five intervention districts compared with counterparts in five randomly selected control districts. Secondary outcomes include HIV prevention knowledge, attitudes, intention to change, agency, discussion, and behaviours.

Batswana researchers are receiving training while participating in the trial implementation and analysis. INSTRUCT is a partnership between the Government of Botswana (National AIDS Coordinating Agency in collaboration with the Ministries of Health and Local Government) and CIET Trust, and is funded by the International Development Research Centre (IDRC) in Canada.