TY - JOUR
T1 - Agents of change among people living with HIV and their social networks
T2 - Stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania
AU - Fawzi, Mary C.Smith
AU - Siril, Hellen
AU - Liu, Yuanyuan
AU - McAdam, Keith
AU - Ainebyona, Donald
AU - McAdam, Elspeth
AU - Somba, Magreat
AU - Oljemark, Kicki
AU - Mleli, Neema
AU - Lienert, Jeffrey
AU - Andrew, Irene
AU - Haberlen, Sabina
AU - Simwinga, Alice
AU - Todd, Jim
AU - Makongwa, Samwel
AU - Li, Nan
AU - Kaaya, Sylvia
N1 - Funding Information:
Funding This research study was funded by the US Centers for Disease Control and Prevention (CDC) (Grant No: TZ/UG.08.0147). Technical and professional staff at the US CDC provided input into the study design and analysis for this manuscript. YL was supported by the UTHealth Innovation for Cancer Prevention Research Training Program Predoctoral or Postdoctoral Fellowship (Cancer Prevention and Research Institute of Texas, Grant No RP160015) at the time of submission.
Publisher Copyright:
© 2019 Author(s).
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Introduction NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. Methods A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. Results For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). Conclusion These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. Trial registration number NCT01693458.
AB - Introduction NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. Methods A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. Results For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). Conclusion These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. Trial registration number NCT01693458.
KW - HIV prevention
KW - behavioural intervention
KW - people living with HIV
KW - social networks
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U2 - 10.1136/bmjgh-2018-000946
DO - 10.1136/bmjgh-2018-000946
M3 - Article
C2 - 31179027
AN - SCOPUS:85065715593
SN - 2059-7908
VL - 4
JO - BMJ Global Health
JF - BMJ Global Health
IS - 3
M1 - e000946
ER -