Clinton Health Access Initiative, Mbabane, Swaziland.
Department of Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands.
BMC Med Ethics. 2019 Jul 16;20(1):50. doi: 10.1186/s12910-019-0384-8.
Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards (CABs) is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini (formerly known as Swaziland), which was implemented as part of the MaxART Early Access to ART for All study.
Trained Swazi research assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role.
The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: (1) promoting ethical conduct, in particular privacy, consent and confidentiality; (2) communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and (3) liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified.
The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning.
在中低收入国家，越来越多地采用社区参与社区为基础的健康研究。使用社区咨询委员会（CAB）是实践社区参与健康研究的一种方法。迄今为止，很少有研究深入描述 CAB 成员用于实践社区参与的策略。我们评估了斯威士兰（前称斯威士兰）第一个当地 CAB 的观点、经验和做法，该 CAB 是作为 MaxART 早期获得所有人 ART 研究的一部分实施的。
经过培训的斯威士兰研究助理与至少参与过 MaxART 研究 2.5 年的 CAB 成员进行了两次焦点小组讨论和 13 次半结构化访谈。访谈探讨了 CAB 的组成和招募情况、CAB 成员的活动、与社区接触的机制以及他们在角色中面临的挑战。
MaxART CAB 在实施早期获得所有人 ART 研究方面发挥了积极作用，活动主要集中在：（1）促进道德行为，特别是隐私、同意和保密性；（2）沟通和教育，就研究进行沟通，并向社区宣传 HIV 检测和早期获得 HIV 治疗的好处；（3）在社区和研究团队之间进行联络。与社区互动的策略多种多样，包括参加一般社区会议、访问保健设施和访问公共场，如牲畜浸泡池、公共汽车、酒吧和教堂。居住在研究地区的 CAB 成员与居住在外地的 CAB 成员在社区参与方式上存在差异。
斯威士兰第一个 CAB 的经验表明，使用 CAB 进行社区参与是一种有价值的机制，可以使社区参与实施研究。可能影响 CAB 运作的考虑因素包括明确界定 CAB 的范围、解决 CAB 独立性问题、CAB 预算、为 CAB 成员提供情感支持，以及为 CAB 成员提供持续的培训和能力建设。这些问题应在 CAB 组建的早期阶段解决，以优化运作。
