Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial
OUTPUT TYPE: Journal Article
PUBLICATION YEAR: 2014
TITLE AUTHOR(S): T.J.Coates, M.Kulich, D.D.Celentano, C.E.Zelaya, S.Chariyalertsak, A.Chingono, G.Gray, J.K.K.Mbwambo, S.F.Morin, L.Richter, M.Sweat, H.Van Rooyen, N.McGrath, A.Fiamma, O.Laeyendecker, E.Piwowar-Manning, G.Szekeres, D.Donnell, S.H.Eshleman, NIMH Project Accept Study Team
KEYWORDS: HIV TESTING AND COUNSELLING (HTC), HIV/AIDS, PROJECT ACCEPT
DEPARTMENT: Public Health, Societies and Belonging (HSC)
Print: HSRC Library: shelf number 8202
HANDLE: 20.500.11910/2486
URI: http://hdl.handle.net/20.500.11910/2486
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at researchoutputs@hsrc.ac.za.
Abstract
Background Although several interventions have shown reduced HIV incidence in clinical trials, the community-level effect of effective interventions on the epidemic when scaled up is unknown. We investigated whether a multicomponent, multilevel social and behavioural prevention strategy could reduce HIV incidence, increase HIV testing, reduce HIV risk behaviour, and change social and behavioural norms. Methods For this phase 3 cluster-randomised controlled trial, 34 communities in four sites in Africa and 14 communities in Thailand were randomly allocated in matched pairs to receive 36 months of community-based voluntary counselling and testing for HIV (intervention group) or standard counselling and testing alone (control group) between January, 2001, and December, 2011. The intervention was designed to make testing more accessible in communities, engage communities through outreach, and provide support services after testing. Randomisation was done by a computer-generated code and was not masked. Data were collected at baseline and after intervention by cross-sectional random surveys of community residents aged 18-32 years. The primary outcome was HIV incidence and was estimated with a cross-sectional multi-assay algorithm and antiretroviral drug screening assay. Thailand was excluded from incidence analyses because of low HIV prevalence. Findings The estimated incidence of HIV in the intervention group was 1.52% versus 1.81% in the control group with an estimated reduction in HIV incidence of 13.9%. HIV incidence was significantly reduced in women older than 24 years), but not in other age or sex subgroups. Community-based voluntary counselling and testing increased testing rates by 25% overall by 45% in men and 15% in women. No overall effect on sexual risk behaviour was recorded. Social norms regarding HIV testing were improved by 6% in communities in the intervention group. Interpretation These results are sufficiently robust, especially when taking into consideration the combined results of modest reductions in HIV incidence combined with increases in HIV testing and reductions in HIV risk behaviour, to recommend the Project Accept approach as an integral part of all interventions (including treatment as prevention) to reduce HIV transmission at the community level.-
Related Research Outputs:
- NIMH Project Accept (HPTN 043): results from in-depth interviews with a longitudinal cohort of community members
- Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand
- A comparative analysis of quantitative and qualitative HIV stigma data from a community based randomized trial in Kwa-Zulu Natal, South Africa (project Accept HPTN 043)
- The development of harmonized minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region: assessment report on HTC policy reviews
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- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Namibia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Zambia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Lesotho