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BACKGROUND: In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. OBJECTIVE: The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. METHODS: We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. RESULTS: This paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. CONCLUSIONS: This trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. TRIAL REGISTRATION: German Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52106.
RESUMEN
INTRODUCTION: The protocol for the management of HIV-positive couples in Togo recommends the systematic use of condoms as the only means of preventing the sexual transmission of HIV. Nevertheless, the incidence of HIV in Togolese serodifferent couples remains high. PURPOSE OF RESEARCH: The aim of the article is to identify barriers to compliance with official guidelines for the prevention of sexual transmission of HIV among serodifferent couples in Lomé. METHODS: The study was qualitative. A literature review was conducted. 48 semi-structured interviews were conducted with 36 PLHIV (10 men and 26 women), 8 health care providers and 4 religious leaders. RESULTS: The religious leaders have a spiritual understanding of HIV infection. They are unfavorable to the use of condoms by couples and advise against it. HIV-positive couples experience psychological difficulties and fear the contamination of the HIV-negative partner, which negatively influences their sexuality. Very few of the couples interviewed respect the protocol of systematic condom use. The reasons for this are reluctance based on psycho-affective barriers, supply difficulties, technical difficulties, religious prohibitions and the desire for a child. CONCLUSIONS: The analysis show significant difficulties for couples in complying with the medical prescriptions in Togo, namely the systematic use of condoms. The analysis of these difficulties makes it possible to highlight on the one hand, the obstacles inherent in the postures of couples and the influence of their socio-cultural environment, and on the other hand, those related to the inadequacies of the offer of HIV services. For better protection, it would be judicious to accentuate their therapeutic education in order to improve and maintain a high level of therapeutic compliance by the seropositive partner.
Introduction: Le protocole de prise en charge des couples sérodifférents au Togo recommande l'utilisation systématique du préservatif comme unique moyen de prévention de la transmission sexuelle du VIH. L'incidence du VIH au sein des couples sérodifférents togolais reste néanmoins élevée. But de l'étude: L'article vise à identifier les entraves au respect des recommandations médicales en matière de prévention de la transmission sexuelle du VIH au sein de couples sérodifférents à Lomé. Méthodes: Il s'agit d'une étude qualitative comprenant une revue documentaire et 48 entretiens semi-directifs réalisés avec 36 PVVIH (10 hommes et 26 femmes), 8 prestataires de soins et 4 leaders religieux. Résultats: Les leaders religieux ont une acception spirituelle de l'infection à VIH. Ils sont défavorables à l'utilisation du préservatif par les couples et la leur déconseillent donc. Les couples sérodifférents vivent des difficultés psychologiques et craignent la contamination du partenaire séronégatif, ce qui influence négativement leur sexualité. Très peu de conjoints séropositifs parmi ceux qui ont été inter-rogés lors des entretiens respectent le protocole d'utilisation systématique du préservatif. Les raisons invoquées sont des réticences basées sur des barrières psychoaffectives, des difficultés d'approvisionnement, des difficultés techniques, les interdits religieux et le désir d'enfant. Conclusions: Les analyses montrent des difficultés importantes pour les couples à se conformer à la prescription en vigueur au Togo, à savoir l'usage systématique du préservatif. L'analyse de ces difficultés permet de mettre en lumière, d'une part, les entraves inhérentes aux postures des couples et à l'influence de leur environnement socioculturel et, d'autre part, celles liées aux insuffisances de l'offre de service de PEC du VIH. Pour une meilleure protection, il serait judicieux d'accentuer leur éducation thérapeutique afin d'améliorer et de maintenir à un niveau élevé le degré d'observance thérapeutique du partenaire séropositif.
