The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe - study design and baseline results
The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe - study design and baseline results
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DOI：
10.1111/j.1365-3156.2008.02137.x
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发表时间：
2008-10-01
影响因子：
3.3
通讯作者：
Hayes, Richard J.
中科院分区：
文献类型：
--
作者：
Cowan, Frances M.;Pascoe, Sophie J. S.;Hayes, Richard J.
目的评价社区青少年艾滋病预防干预在以下方面的效果：(1)艾滋病毒和单纯疱疹病毒2型（HSV-2）的发病率和意外怀孕率；(2)性行为报告、性知识和性态度。方法对津巴布韦农村青少年进行多成分艾滋病毒预防干预的聚类随机试验。2003年，选择并随机分配了30个社区进行早期或推迟干预实施。在实施干预之前，对6791名中学生（86%的合格学生）进行了基线生物行为调查。结果HIV的基线患病率为0.8% (95% CI: 0.6-1.0)， HSV-2的基线患病率为0.2% （95% CI: 0.1-0.3%）。4名女孩（0.12%）怀孕。两个研究组之间有很好的平衡。占队列35%的孤儿感染艾滋病毒的风险增加[年龄-性别校正优势比为3.4 (95% CI: 1.7-6.5)]。11.9%的年轻男性和2.9%的年轻女性报告性活跃（P < 0.001）；然而，在性行为数据中存在不一致的地方。女孩比男孩更不可能了解生殖健康问题（P < 0.001），使用和能够获得避孕套的可能性更小（P < 0.001）。这是对南部非洲以社区为基础的年轻人艾滋病毒预防干预措施进行的首批严格评估之一。艾滋病毒的低感染率表明，干预措施是在这一人群性活跃之前开始的。性行为的不一致和少报再次强调了在行为干预研究中使用外部验证的减少性风险措施的重要性。
Objective To assess the effectiveness of a community-based HIV prevention intervention for adolescents in terms of its impact on (1) HIV and Herpes simplex virus type 2 (HSV-2) incidence and on rates of unintended pregnancy and (2) reported sexual behaviour, knowledge and attitudes.Methods Cluster randomised trial of a multi-component HIV prevention intervention for adolescents based in rural Zimbabwe. Thirty communities were selected and randomised in 2003 to early or deferred intervention implementation. A baseline bio-behavioural survey was conducted among 6791 secondary school pupils (86% of eligibles) prior to intervention implementation.Results Baseline prevalences were 0.8% (95% CI: 0.6-1.0) for HIV and 0.2% (95% CI: 0.1-0.3%) for HSV-2. Four girls (0.12%) were pregnant. There was excellent balance between study arms. Orphans who made up 35% of the cohort were at increased risk of HIV [age-sex adjusted odds ratio 3.4 (95% CI: 1.7-6.5)]. 11.9% of young men and 2.9% of young women reported that they were sexually active (P < 0.001); however, there were inconsistencies in the sexual behaviour data. Girls were less likely to know about reproductive health issues than boys (P < 0.001) and were less likely to have used and to be able to access condoms (P < 0.001).Conclusion This is one of the first rigorous evaluations of a community-based HIV prevention intervention for young people in southern Africa. The low rates of HIV suggest that the intervention was started before this population became sexually active. Inconsistency and under-reporting of sexual behaviour re-emphasise the importance of using externally validated measures of sexual risk reduction in behavioural intervention studies.