Empowerment through Education and Entrepreneurship for Indigenous Adolescents in Ecuador

Role:    Principal Investigator
Agency:  Brown Population Studies and Training Center
Period:  March 1, 2023 to February 29, 2024

We propose to adapt and evaluate a multifaceted program to break the cycle of low-skilled jobs and high fertility among Indigenous Adolescents (IA) in Ecuador. The program will enhance human capital in two ways: (1) by providing entrepreneurial skills to enable IA to start income-generating activities; and (2) by increasing access to comprehensive sexuality education to enable IA to make informed decisions about sex, reproduction, and marriage. Research activities will include program adaptation based on cultural norms, and a pilot to test feasibility and acceptability. Sexual health education will be delivered through an existing online platform, and vocational modules will be delivered in afterschool “entrepreneurship clubs”. We will culturally adapt the program to Cotacachi, Imbabura, Ecuador (a region with high indigenous concentration), and recruit N=60 male and female IA in their last years of high school in Cotacachi to participate in the pilot study. Thirty (30) IA will go through the program over a semester, and n=30 will serve as a control, comparison group. These clubs will provide safe spaces for IA to meet and socialize with other adolescents. Similar programs have been successful in Bangladesh (through BRAC) and Uganda; the proposed study will provide novel evidence of the program’s feasibility and acceptability in Latin America.

• Ecuador PSTC Seed Pilot_Project Protocol 20June23

Summary of available datasets:

• Medicaid claims data from 14 high HIV prevalence states (2001- 2012) and data from an additional three more years of Medicaid claims (2013-2015) including Medicare Parts A, B and D claims from ~300,000 HIV infected beneficiaries across the country from 2006-2015

• Galárraga O, Bohlen LC, Dunsiger SI, Lee HH, Emerson JA, Boyle HK, Strohacker K, Williams DM. “Small sustainable monetary donation-based incentives to promote physical activity: A randomized controlled trial.” Health Psychology, vol. 39, no. 4, 2020, pp. 265-268.

• Salinas-Rodríguez A, Sosa-Rubí SG, Chivardi C, Rodríguez-Franco R, Gandhi M, Mayer KH, Operario D, Gras-Allain N, Vargas-Guadarrama G, Galárraga O. Preferences for Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence: A Discrete Choice Experiment among Male Sex Workers in Mexico. AIDS & Behavior. 2021 Aug 27
• Kadiamada-Ibarra, H., Hawley, N.L., Sosa-Rubí, S.G. et al. Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework. BMC Public Health 21, 2174 (2021). https://doi.org/10.1186/s12889-021-12167-9

Summary of available datasets:

• Self-reported baseline and follow-up data (months 0, 3, 6) from n=200 male sex workers (MSWs) in Mexico City that captures sociodemographic characteristics and sexual risk behaviors of MSWs and their most recent clients
  • AIM2 Baseline English PrEP Seguro Survey
  • AIM2 Follow-Up PrEP Seguro Survey
  • Exit Interview English Stand-Alone Version
• Baseline and follow-up data (months 0, 3, 6) from n=200 male sex workers (MSWs) in Mexico city measuring TFV/FTC concentrations (a biological marker of Pre-Exposure Prophylaxis adherence) in hair samples
  • Filemaker variables

• Tran DN, Ching J, Kafu C, et al. Interruptions to HIV Care Delivery During Pandemics and Natural Disasters: A Qualitative Study of Challenges and Opportunities From Frontline Healthcare Providers in Western Kenya. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2023;22. doi:10.1177/23259582231152041
• Kafu C, Wachira J, Omodi V, Said J, Pastakia SD, Tran DN, Onyango JA, Aburi D, Wilson-Barthes M, Galárraga O, Genberg BL. Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya. Pilot Feasibility Stud. 2022 Dec 28;8(1):266. doi: 10.1186/s40814-022-01218-6. PMID: 36578093; PMCID: PMC9795156.
• Genberg, B. L., Wachira, J., Steingrimsson, J. A., Pastakia, S., Tran, D., Said, J. A., Braitstein, P., Hogan, J. W., Vedanthan, R., Goodrich, S., Kafu, C., Wilson-Barthes, M., & Galárraga, O. (2021). Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial. BMJ open, 11(5), e042662. https://doi.org/10.1136/bmjopen-2020-042662
• Genberg BL, Wilson-Barthes MG, Omodi V, Hogan JW, Steingrimsson J, Wachira J, Pastakia S, Tran DN, Kiragu ZW, Ruhl LJ, Rosenberg M, Kimaiyo S, Galárraga O. Microfinance, retention in care, and mortality among patients enrolled in HIV care in East Africa. AIDS. 2021 Oct 1;35(12):1997-2005. doi: 10.1097/QAD.0000000000002987. PMID: 34115646.
• Pastakia SD, Braitstein P, Galárraga O, Genberg B, Said J, Vedanthan R, Wachira J, Hogan JW. Preserving 2 decades of healthcare gains for Africa in the coronavirus disease 2019 era. AIDS. 2020 Oct 1;34(12):1761-1763. doi: 10.1097/QAD.0000000000002605. PMID: 32889851; PMCID: PMC7493772.

Summary of available datasets:

• Objectively measured clinical data on HIV viral load (copies/mL), systolic/diastolic blood pressure (mm Hg), Hemoglobin A1c levels (mmol/mol), random blood sugar (mmol/L), obtained for n=1200 participants at months 0 and 18

• Self-reported longitudinal data (baseline, month 9, month 18) from n=1200 patients living with HIV that captures the following constructs: health insurance utilization (e.g., NHIF), household economic status (Demographic & Health Survey, DHS, Wealth Index), food security (Household Food Insecurity Access Scale), barriers to accessing HIV care, social support (Oslo Social Support Scale), internalized HIV stigma, quality of life (adapted MOS-HIV), the Patient Health Questionnaire-2 (PHQ-2), medication adherence (adapted AIDS Clinical Trial Group adherence and Voils DOSE-Nonadherence questionnaire), patient-reported satisfaction with care
• Baseline and quarterly data from n=900 members of self-sustaining microfinance groups that captures individual- and group- level income generation and saving and lending activities
• Harambee Aim 1 Codebook v8_Datasets 1-9 26July2023
• Aim 1 Harambee Survey Assessment Tool _ REDCap