Research That Matters (January 17 - 20, 2008)

Background and Purpose: The Champ Family Program has responded to the global epidemic of HIV/AIDS by implementing community collaborative partnerships in the United States, the Caribbean and South Africa. The CHAMP Family Program examines the impact of a community-level intervention to disseminate evidence-based HIV prevention programs for vulnerable youth. The purpose of this particular study was to adapt CHAMP to the South African context where HIV rates are among the highest in the world.

Methods: Adapted from the CHAMP Family Program, CHAMP-South Africa (CHAMPSA) consists of 10 sessions delivered via multi-family groups focusing on increasing HIV knowledge, decreasing HIV stigma, strengthening protective parenting styles, improving family decision making, increasing monitoring of caregivers' children, improving familial communications and increasing social fabric. The intervention is delivered in Zulu, using community caregivers trained in the intervention and overseen by a community collaborative board. Participants were recruited from the semi-rural community of Kwadedangendlale and randomized into two conditions, the CHAMPSA intervention and existing educational programs provided by primary schools and community education resources. A sample of 579 children, ages 9-13 years old, and their caregivers were assessed at baseline, post-intervention and 6 and 18-month follow-up. Data was analyzed using pre- and post-test change scores, and assessed using mixed effects regression model.

Results: The youth sample was made up of 41% boys (N=237) and 59% girls (N=340). Almost all the caregivers were Zulu-speaking, with mothers comprising 48% (N=227) of the sample and fathers at 52% (N=250) of participating caregivers. Preliminary analyses reveal positive association with multi-level outcomes. More specifically, involvement in the CHAMPSA Family Program was associated with youth reports of significant increases in the following domains relative to comparison youth: frequency of parent child communication (F=13.2; p<.001); AIDS knowledge (F=8.5; p<.01); and perceptions of parental monitoring (F=12.5; p<.001). In addition, significant reductions in stigma associated with AIDS (F=24.2; p<.001) and endorsement of AIDS myths (F=8.9; p<.01) were associated with CHAMPSA involvement relative to comparison youth. In addition, significant changes in caregiver reports of AIDS knowledge (F=16.3; p<.001), family decision making (F=50.0; p<.01), communication comfort (F=32.7; p<.001), communication frequency (F=46.3; p<.001), and monitoring (F=9.3; p<.001) were associated with CHAMPSA participation relative to caregiver responses in the comparison condition.

Conclusions and Implications: Under-resourced settings with significant public health concerns such as the HIV/AIDS epidemic can benefit from the use of community participation in the design and delivery of interventions. Consistently targeting individual, family and community-level outcomes, the CHAMP program has shown its ability to effectively produce similar results across international contexts. This community collaborative approach can serve as a model for the global response to HIV/AIDS by ensuring the transportability and universality of evidence-informed programs, which ensures the cultural relativity of interventions aimed at strengthening protective factors associated with risky youth behaviors. These programs can potentially have a substantial impact on the role of families as a shield for protecting youth against HIV exposure by decreasing stigma, while increasing HIV/AIDS knowledge, family communication and overall family cohesion in communities significantly impacted by the AIDS epidemic.