Project Shikamana: Community Empowerment-Based Combination HIV Prevention Significantly Impacts HIV Incidence and Care Continuum Outcomes Among Female Sex Workers in Iringa, Tanzania
Project Shikamana: Community Empowerment-Based Combination HIV Prevention Significantly Impacts HIV Incidence and Care Continuum Outcomes Among Female Sex Workers in Iringa, Tanzania
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DOI：
10.1097/qai.0000000000002123
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发表时间：
2019-10-01
影响因子：
3.6
通讯作者：
Galai, Noya
中科院分区：
文献类型：
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作者：
Kerrigan, Deanna;Mbwambo, Jessie;Galai, Noya
目的：探讨社区赋权模式在坦桑尼亚伊林加女性性工作者中的效果。方法：采用两社区随机试验。干预内容包括：(1)社区主导的救助中心和动员活动；(2)以场所为基础的同伴教育、避孕套分发和艾滋病毒检测；(3)同伴服务导航；(4)提供者敏感性培训；(5)短信提醒。我们采用时间-地点抽样的方法招募了496名FSW，并在0个月和18个月时进行了一次调查和抽血以筛查HIV并评估病毒载量。我们对主要结果进行了意向治疗分析，使用Logistic和Poisson回归和逆概率加权。结果：分析包括171名HIV阳性和216名HIV阴性的FSW，他们完成了基线和18个月的研究访问。干预的参与者在18个月的随访中感染艾滋病毒的可能性显著降低(RR0.38；P=0.047)，干预组的艾滋病毒发病率为5.0%，对照组为10.4%。随着时间的推移，干预组安全套不一致使用率(72.0%-43.6%)显著高于对照组(68.8%-54.0%；RR0.81，P=0.042)。在随访中，我们观察到行为HIV护理连续结果的显著差异，并且干预组与对照组(35.9%-47.4%)相比，病毒抑制(40.0%-50.6%)增加了，但不显著。更高的干预暴露与包括病毒抑制在内的HIV结果有很强的相关性。结论：Shikamana项目是非洲FSW中第一个基于社区赋权的联合预防试验，显示艾滋病毒发病率显著降低，值得更广泛地实施和评估。
Objective: To determine the impact of a community empowerment model of combination HIV prevention (Project Shikamana) among female sex workers (FSW) in Iringa, Tanzania.Methods: We conducted a 2-community randomized trial. Intervention elements included the following: (1) Community-led drop-in center and mobilization activities; (2) venue-based peer education, condom distribution, and HIV testing; (3) peer service navigation; (4) provider sensitivity trainings; and (5) SMS reminders. We used time-location sampling to enroll 496 FSW and conducted a survey and blood draws to screen for HIV and assess viral load at 0 and 18 months. We conducted an intent-to-treat analysis using logistic and Poisson regression and inverse probability weighting for primary outcomes.Results: The analysis included 171 HIV-positive and 216 HIV-negative FSW who completed baseline and 18-month study visits. Participants in the intervention were significantly less likely to become infected with HIV at 18-month follow-up (RR 0.38; P = 0.047), with an HIV incidence of 5.0% in the intervention vs. 10.4% control. Decreases in inconsistent condom use over time were significantly greater in the intervention (72.0%-43.6%) vs. control (68.8%-54.0%; RR 0.81, P = 0.042). At follow-up, we observed significant differences in behavioral HIV care continuum outcomes, and positive, but nonsignificant, increases in viral suppression (40.0%-50.6%) in the intervention vs. control (35.9%-47.4%). There was a strong association of between higher intervention exposure and HIV outcomes including viral suppression.Conclusions: Project Shikamana is the first trial of community empowerment-based combination prevention among FSW in Africa to show a significant reduction in HIV incidence warranting its broader implementation and evaluation.