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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): A cluster-randomised trial
The Lancet Global Health, Volume 2, No. 5, Year 2014
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Description
Background: Although several interventions have shown reduced HIV incidence in clinical trials, the community-level effect of effective interventions on the epidemic when scaled up is unknown. We investigated whether a multicomponent, multilevel social and behavioural prevention strategy could reduce HIV incidence, increase HIV testing, reduce HIV risk behaviour, and change social and behavioural norms. Methods: For this phase 3 cluster-randomised controlled trial, 34 communities in four sites in Africa and 14 communities in Thailand were randomly allocated in matched pairs to receive 36 months of community-based voluntary counselling and testing for HIV (intervention group) or standard counselling and testing alone (control group) between January, 2001, and December, 2011. The intervention was designed to make testing more accessible in communities, engage communities through outreach, and provide support services after testing. Randomisation was done by a computer-generated code and was not masked. Data were collected at baseline (n=14 567) and after intervention (n=56 683) by cross-sectional random surveys of community residents aged 18-32 years. The primary outcome was HIV incidence and was estimated with a cross-sectional multi-assay algorithm and antiretroviral drug screening assay. Thailand was excluded from incidence analyses because of low HIV prevalence. This trial is registered at ClinicalTrials.gov, number NCT00203749. Findings: The estimated incidence of HIV in the intervention group was 1·52% versus 1·81% in the control group with an estimated reduction in HIV incidence of 13·9% (relative risk [RR] 0·86, 95% CI 0·73-1·02; p=0·082). HIV incidence was significantly reduced in women older than 24 years (RR=0·70, 0·54-0·90; p=0·0085), but not in other age or sex subgroups. Community-based voluntary counselling and testing increased testing rates by 25% overall (12-39; p=0·0003), by 45% (25-69; p<0·0001) in men and 15% (3-28; p=0·013) in women. No overall effect on sexual risk behaviour was recorded. Social norms regarding HIV testing were improved by 6% (95% CI 3-9) in communities in the intervention group. Interpretation: These results are sufficiently robust, especially when taking into consideration the combined results of modest reductions in HIV incidence combined with increases in HIV testing and reductions in HIV risk behaviour, to recommend the Project Accept approach as an integral part of all interventions (including treatment as prevention) to reduce HIV transmission at the community level. © 2014 Coates et al.
Authors & Co-Authors
Coates, Thomas J.
United States, Los Angeles
University of California, Los Angeles
Kulich, Michal
Czech Republic, Prague
Charles University
Celentano, David D.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Zelaya, Carla E.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Chariyalertsak, Suwat
Thailand, Chaing Mai
Chiang Mai University
Chingono, Alfred H.
Zimbabwe, Harare
University of Zimbabwe
Gray, Glenda E.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Mbwambo, Jessie Kazeni Kilonzo
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Morin, Stephen F.
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Richter, Linda M.
South Africa, Pretoria
Human Sciences Research Council of South Africa
Sweat, Michael D.
United States, Charleston
Medical University of South Carolina
Van-Rooyen, Heidi E.
South Africa, Pretoria
Human Sciences Research Council of South Africa
McGrath, Nuala M.
United Kingdom, Southampton
University of Southampton
Fiamma, Agnès
United States, Los Angeles
University of California, Los Angeles
Laeyendecker, Oliver B.
United States, Baltimore
Johns Hopkins School of Medicine
United States, Bethesda
National Institutes of Health Nih
Piwowar-Manning, Estelle M.
Unknown Affiliation
Szekeres, Greg
United States, Los Angeles
University of California, Los Angeles
Donnell, Deborah J.
United States, Seattle
Fred Hutchinson Cancer Research Center
Eshleman, Susan H.
Unknown Affiliation
Statistics
Citations: 138
Authors: 19
Affiliations: 14
Identifiers
Doi:
10.1016/S2214-109X(14)70032-4
e-ISSN:
2214109X
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Participants Gender
Male
Female