BibTex format
@article{Gregson:2007:10.1371/journal.pmed.0040102,
author = {Gregson, S and Adamson, S and Papaya, S and Mundondo, J and Nyamukapa, CA and Mason, PR and Garnett, GP and Chandiwana, SK and Foster, G and Anderson, RM},
doi = {10.1371/journal.pmed.0040102},
journal = {PLOS Medicine},
pages = {545--555},
title = {Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe},
url = {http://dx.doi.org/10.1371/journal.pmed.0040102},
volume = {4},
year = {2007}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BackgroundHIV-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 FindingsWe 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).ConclusionsIntegrated 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.
AU - Gregson,S
AU - Adamson,S
AU - Papaya,S
AU - Mundondo,J
AU - Nyamukapa,CA
AU - Mason,PR
AU - Garnett,GP
AU - Chandiwana,SK
AU - Foster,G
AU - Anderson,RM
DO - 10.1371/journal.pmed.0040102
EP - 555
PY - 2007///
SN - 1549-1277
SP - 545
TI - Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe
T2 - PLOS Medicine
UR - http://dx.doi.org/10.1371/journal.pmed.0040102
VL - 4
ER -