Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2007 Mar 27;4(3):e102.
doi: 10.1371/journal.pmed.0040102.

Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe

Simon Gregson  1 , Saina Adamson, Spiwe Papaya, Jephias Mundondo, Constance A Nyamukapa, Peter R Mason, Geoffrey P Garnett, Stephen K Chandiwana, Geoff Foster, Roy M Anderson
Affiliations
Randomized Controlled Trial

Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe

Simon Gregson et al. PLoS Med. .

Abstract

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 sub-groups.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Location of Intervention and Control Communities in Manicaland Province, Eastern Zimbabwe
Figure 2
Figure 2. Flow-Chart Comparing Participation and Follow-Up Rates in the Intervention and Control Communities
Individuals enrolled in round 1 and still resident in the study communities were considered eligible for participation in round 2.
See this image and copyright information in PMC

References

    1. Asamoah-Odei E, Garcia Calleja JM, Boerma JT. HIV prevalence and trends in sub-Saharan Africa: No decline and large subregional differences. Lancet. 2004;364:35–40. - PubMed
    1. Anderson RM, May RM. Infectious diseases of humans: Dynamics and control. Oxford: Oxford University Press; 1991. 757
    1. Watkins SC. Navigating the AIDS epidemic in rural Malawi. Popul Dev Rev. 2005;30:673–705.
    1. UNAIDS. Trends in HIV incidence and prevalence: Natural course of the epidemic or results of behaviour change? Geneva: UNAIDS; 1999. 36
    1. Stephenson JM, Obasi A. HIV risk reduction in adolescents. Lancet. 2004;363:1177–1178. - PubMed

Publication types