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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact and process evaluation of integrated community and clinic-based HIV-1 control: A cluster-randomised trial in Eastern Zimbabwe
PLoS Medicine, Volume 4, No. 3, Year 2007
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Description
Background: HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels. Methods and Findings: We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92-1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24-0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28-0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21-5.12). Conclusions: Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population subgroups. © 2007 Gregson et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC1831737/bin/pmed.0040102.sd001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC1831737/bin/pmed.0040102.sd002.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC1831737/bin/pmed.0040102.sd003.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC1831737/bin/pmed.0040102.sd004.pdf
Authors & Co-Authors
Gregson, Simon A.J.
United Kingdom, London
Imperial College London
Zimbabwe, Harare
Biomedical Research and Training Institute Harare
Adamson, Saina
Zimbabwe, Harare
Biomedical Research and Training Institute Harare
Papaya, Spiwe
Zimbabwe, Mutare
Family Aids Caring Trust Mutare
Mundondo, J.
Zimbabwe, Mutare
Family Aids Caring Trust Mutare
Nyamukapa, Constance Anesu
United Kingdom, London
Imperial College London
Zimbabwe, Harare
Biomedical Research and Training Institute Harare
Mason, Peter R.
Zimbabwe, Harare
Biomedical Research and Training Institute Harare
Garnett, Geoff Peter
United Kingdom, London
Imperial College London
Chandiwana, Stephen K.
Zimbabwe, Harare
Biomedical Research and Training Institute Harare
South Africa, Johannesburg
University of the Witwatersrand
Foster, Geoff
Zimbabwe, Mutare
Family Aids Caring Trust Mutare
Anderson, Roy Malcolm
United Kingdom, London
Imperial College London
Statistics
Citations: 146
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pmed.0040102
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Case-Control Study
Study Locations
Zimbabwe
Participants Gender
Male