Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the intervention in Dar es Salaam, Tanzania.

Journal: BMJ global health

Volume: 4

Issue: 3

Year of Publication: 

Affiliated Institutions:  Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. Management and Development for Health, Dar es Salaam, Tanzania. NAMWEZA Centre, London, UK. Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. Department of Health, Dar es Salaam, Tanzania. Population Health, London School of Hygiene and Tropical Medicine, London, UK. Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.

Abstract summary 

is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members.A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV.For people living with HIV, a number of outcomes improved with the intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002).These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions.NCT01693458.

Authors & Co-authors:  Smith Fawzi Mary C MC Siril Hellen H Liu Yuanyuan Y McAdam Keith K Ainebyona Donald D McAdam Elspeth E Somba Magreat M Oljemark Kicki K Mleli Neema N Lienert Jeffrey J Andrew Irene I Haberlen Sabina S Simwinga Alice A Todd Jim J Makongwa Samwel S Li Nan N Kaaya Sylvia S

Study Outcome 

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Statistics
Citations :  Palella FJ, Delaney KM, Moorman AC, et al. . Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338:853–60. 10.1056/NEJM199803263381301
Authors :  17
Identifiers
Doi : e000946
SSN : 2059-7908
Study Population
Male,Female
Mesh Terms
Other Terms
HIV prevention;behavioural intervention;people living with HIV;social networks
Study Design
Study Approach
Country of Study
Tanzania
Publication Country
England