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Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

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Abstract

We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes.

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Authors and Affiliations

  1. Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA

    Pamela Bachanas, Daniel Kidder, Amy Medley, Sherri L. Pals & Janet Moore

  2. Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Dar Es Salaam, United Republic of Tanzania

    Deborah Carpenter

  3. ICAP, Columbia University, New York, NY, USA

    Andrea Howard

  4. ICAP-Tanzania, Columbia University, Dar Es Salaam, United Republic of Tanzania

    Gretchen Antelman

  5. Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia

    Nicolas DeLuca

  6. Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya

    Odylia Muhenje

  7. ICAP-Kenya, Columbia University, Nairobi, Kenya

    Muhsin Sheriff

  8. Ministry of Health and Social Welfare, Dar Es Salaam, United Republic of Tanzania

    Geoffrey Somi

  9. Ministry of Health and Social Services, Windhoek, Namibia

    Frieda Katuta

  10. National AIDS/STD Control Programme (NASCOP), Nairobi, Kenya

    Peter Cherutich

Authors
  1. Pamela Bachanas
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  2. Daniel Kidder
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  3. Amy Medley
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  4. Sherri L. Pals
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  5. Deborah Carpenter
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  6. Andrea Howard
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  7. Gretchen Antelman
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  8. Nicolas DeLuca
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  9. Odylia Muhenje
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  10. Muhsin Sheriff
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  11. Geoffrey Somi
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  12. Frieda Katuta
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  13. Peter Cherutich
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  14. Janet Moore
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Corresponding author

Correspondence to Pamela Bachanas.

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For the PwP Evaluation Study Team.

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Bachanas, P., Kidder, D., Medley, A. et al. Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania. AIDS Behav 20, 2110–2118 (2016). https://doi.org/10.1007/s10461-016-1349-2

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  • DOI: https://doi.org/10.1007/s10461-016-1349-2

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