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Randomized Controlled Trial
. 2016 Sep;20(9):2110-8.
doi: 10.1007/s10461-016-1349-2.

Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

Pamela Bachanas  1 , Daniel Kidder  2 , Amy Medley  2 , Sherri L Pals  2 , Deborah Carpenter  3 , Andrea Howard  4 , Gretchen Antelman  5 , Nicolas DeLuca  6 , Odylia Muhenje  7 , Muhsin Sheriff  8 , Geoffrey Somi  9 , Frieda Katuta  10 , Peter Cherutich  11 , Janet Moore  2
Affiliations
Randomized Controlled Trial

Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

Pamela Bachanas et al. AIDS Behav. 2016 Sep.

Abstract

We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes.

Keywords: HIV prevention; HIV/AIDS; People living with HIV; Sub-Saharan Africa.

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Figures

Fig. 1
Fig. 1
Summary of model for integrating HIV prevention messages and services into the routine care offered to HIV-positive patients attending clinical care in Kenya, Tanzania, and Namibia
Fig. 2
Fig. 2
Flow diagram showing follow-up of HIV-positive patients enrolled in a group randomized control trial. Note Unable to interview includes unable to locate, transferred to another clinic, and declined interview
See this image and copyright information in PMC

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