Impact and process evaluation of integrated community and clinic-based HIV-1 control: A cluster-randomised trial in eastern Zimbabwe
Impact and process evaluation of integrated community and clinic-based HIV-1 control: A cluster-randomised trial in eastern Zimbabwe
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DOI：
10.1371/journal.pmed.0040102
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发表时间：
2007-03-01
期刊：
影响因子：
15.8
通讯作者：
Anderson, Roy M.
中科院分区：
文献类型：
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作者：
Gregson, Simon;Adamson, Saina;Anderson, Roy M.
背景撒哈拉以南非洲的HIV-1控制需要具有成本效益且可持续的计划，以促进人群和个人层面的行为改变并减少辅助因素性传播感染（STI）。方法和结果我们衡量了基于社区的同伴教育、免费的可行性避孕套分发、创收项目、和诊所为基础的性传播感染治疗和咨询服务，并评估其对艾滋病毒-1的发病率的影响，在津巴布韦东部的一个集群随机对照试验中测量了3年的时间。主要结局分析基于意向治疗。在当前的经济环境下，创收项目证明是不可能实施的。尽管干预社区的方案活动和知识更多，但与对照社区相比，HIV-1的发病率比为1.27（95%置信区间[CI] 0.92-1.75）。没有证据表明，在干预社区，自我报告的性传播感染症状或高风险性行为的发生率有所降低。参加方案会议的男性HIV-1发病率较低（发病率比0.48，95% CI 0.24-0.98），参加方案会议的男性报告与临时伴侣发生无保护性行为的人数较少（比值比0.45，95% CI 0.28-0.75）。更多的男性性病患者在干预社区报告停止症状（比值比2.49，95%CI 1.21-5.12）。结论综合同伴教育，避孕套的分发，综合征性性病管理并没有减少人口水平的HIV-1发病率下降的流行，尽管减少HIV-1的发病率在直接的男性目标群体。我们的研究结果强调，需要评估干预措施，是有效的目标人群亚群之间的社区一级的影响。
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 subgroups.