Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial.
Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial.
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DOI：
10.1136/bmj.a506
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发表时间：
2008-08-07
期刊：
影响因子：
--
通讯作者：
Duvvury N
中科院分区：
文献类型：
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作者：
Jewkes R;Nduna M;Levin J;Jama N;Dunkle K;Puren A;Duvvury N
目的评价“踏脚石”项目对艾滋病病毒（HIV）感染率、单纯疱疹病毒2型（HSV-2）感染率和性行为的影响。设计：整群随机对照试验。设置南非东开普省70个村（群）。参与者1360名男性和1416名女性，年龄在15-26岁之间，他们大多在上学。“干预基石”是一个50小时的方案，旨在通过使用参与式学习方法来积累知识、风险意识和沟通技能，并激发批判性反思，从而改善性健康。村庄被随机分配接受这一干预或三小时的艾滋病毒和安全性行为干预。访谈者在基线和12个月和24个月时进行问卷调查，并对血液进行HIV和HSV-2检测。主要观察指标：HIV感染率。其他结果：HSV-2的发病率，意外怀孕，报告的性行为，抑郁症和药物滥用。结果没有证据表明踏脚石降低了HIV的发病率（调整后的发病率比为0.95，95%可信区间为0.67 ~ 1.35）。该计划与HSV-2发病率降低约33%（0.67，0.46至0.97; P=0.036）相关-也就是说，踏脚石在两年内将新发HSV-2感染的数量减少了34.9（1.6至68.2）/1000暴露者。踏脚石显著改善了男性报告的一些风险行为，在两年的随访中，报告实施亲密伴侣暴力的男性比例较低，12个月时交易性行为和问题饮酒较少。在妇女中，没有报告期望的行为改变，而那些参加踏脚石方案的妇女在12个月时报告了更多的性交易。结论垫脚石并没有降低艾滋病的发病率，但对艾滋病的几个危险因素有影响，特别是HSV-2和亲密伴侣暴力的实施。临床试验注册NCT 00332878。
Objective To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour. Design Cluster randomised controlled trial. Setting 70 villages (clusters) in the Eastern Cape province of South Africa. Participants 1360 men and 1416 women aged 15-26 years, who were mostly attending schools. Intervention Stepping Stones, a 50 hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. Villages were randomised to receive either this or a three hour intervention on HIV and safer sex. Interviewers administered questionnaires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2. Main outcome measures Primary outcome measure: incidence of HIV. Other outcomes: incidence of HSV-2, unwanted pregnancy, reported sexual practices, depression, and substance misuse. Results There was no evidence that Stepping Stones lowered the incidence of HIV (adjusted incidence rate ratio 0.95, 95% confidence interval 0.67 to 1.35). The programme was associated with a reduction of about 33% in the incidence of HSV-2 (0.67, 0.46 to 0.97; P=0.036)—that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 (1.6 to 68.2) per 1000 people exposed. Stepping Stones significantly improved a number of reported risk behaviours in men, with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months. In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months. Conclusion Stepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV—notably, HSV-2 and perpetration of intimate partner violence. Trial Registration Clinical Trials NCT00332878.
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影响因子：
5.4
作者：
Gallant, M;Maticka-Tyndale, E
通讯作者：
Maticka-Tyndale, E
影响因子：
3.3
作者：
Jewkes, R;Nduna, M;Duvvury, N
通讯作者：
Duvvury, N
影响因子：
--
作者：
Sarge-Njie, Ramu;Van der Loeff, Maarten Schim;Whittle, Hilton
通讯作者：
Whittle, Hilton
影响因子：
3.8
作者：
Dunkle, Kristin L.;Jewkes, Rachel K.;Duvvury, Nata
通讯作者：
Duvvury, Nata
DOI：
10.1128/cdli.9.6.1338-1342.2002
发表时间：
2002-11-01
期刊：
CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY
影响因子：
--
作者：
Hogrefe, WR;Ernst, C;Su, X
通讯作者：
Su, X