The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth.
The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth.
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Regai dzive Shiri项目：针对青年进行HIV预防干预的随机试验结果。
DOI：
10.1097/qad.0b013e32833e77c9
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发表时间：
2010-10-23
期刊：
影响因子：
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通讯作者：
Regai Dzive Shiri trial team
中科院分区：
文献类型：
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作者：
Cowan FM;Pascoe SJ;Langhaug LF;Mavhu W;Chidiya S;Jaffar S;Mbizvo MT;Stephenson JM;Johnson AM;Power RM;Woelk G;Hayes RJ;Regai Dzive Shiri trial team
在南部非洲的年轻人中预防艾滋病毒是一个公共卫生优先事项。几乎没有严格的证据表明不同干预方法的有效性。我们描述了一项旨在改变津巴布韦农村青少年社会规范的社区、多成分艾滋病毒和生殖健康干预的整群随机试验的结果。2003年，30个农村社区被随机分为提前或推迟实施干预措施。4年后，在对18-22岁青少年的代表性调查中对影响进行了评估。参与者自行完成问卷调查，并提供干血点样本进行HIV和HSV-2抗体检测。年轻女性接受了尿液妊娠测试。分析采用意向处理，并针对分组进行了调整。4684名18-22岁的年轻人参加了调查(97.1%的符合条件的人，55.5%的女性)。略高于40%的人曾参加过≥10干预会议。干预社区的青年男女在知识和态度方面略有改善，但对自我报告的性行为没有影响。干预对HIV或HSV-2的流行率和当前妊娠均无影响。干预社区的妇女报告怀孕的可能性较小。尽管这种干预措施对知识、一些态度和报告的怀孕情况有影响，但对艾滋病毒或单纯疱疹病毒2型的流行没有影响，这进一步证明，仅靠行为干预不太可能足以扭转艾滋病毒的流行。面对艾滋病毒持续和令人无法接受的高发病率，特别是在年轻妇女中，仍然面临着为年轻人找到有效的艾滋病毒预防办法的挑战。
HIV prevention among young people in southern Africa is a public health priority. There is little rigorous evidence of the effectiveness of different intervention approaches. We describe findings of a cluster randomised trial of a community-based, multi-component HIV and reproductive health intervention aimed at changing social norms for adolescents in rural Zimbabwe. Thirty rural communities were randomised to early or deferred implementation of the intervention in 2003. Impact was assessed in a representative survey of 18–22 year olds after 4 years. Participants self-completed a questionnaire and gave a dried blood spot sample for HIV and HSV-2 antibody testing. Young women had a urinary pregnancy test. Analyses were by intention-to-treat and were adjusted for clustering. 4,684 18–22 year olds participated in the survey (97.1% of eligibles, 55.5% female). Just over 40% had been exposed to ≥ 10 intervention sessions. There were modest improvements in knowledge and attitudes among young men and women in intervention communities, but no impact on self-reported sexual behaviour. There was no impact of the intervention on prevalence of HIV or HSV-2 or current pregnancy. Women in intervention communities were less likely to report ever having been pregnancy. Despite an impact on knowledge, some attitudes and on reported pregnancy, there was no impact of this intervention on HIV or HSV-2 prevalence, further evidence that behavioural interventions alone are unlikely to be sufficient to reverse the HIV epidemic. The challenge remains to find effective HIV prevention approaches for young people in the face of continued and unacceptably high HIV incidence, particularly among young women.