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AIDS and Behavior

, Volume 20, Issue 9, pp 2110–2118 | Cite as

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

  • Pamela BachanasEmail author
  • Daniel Kidder
  • Amy Medley
  • Sherri L. Pals
  • Deborah Carpenter
  • Andrea Howard
  • Gretchen Antelman
  • Nicolas DeLuca
  • Odylia Muhenje
  • Muhsin Sheriff
  • Geoffrey Somi
  • Frieda Katuta
  • Peter Cherutich
  • Janet Moore
Original Paper

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.

Keywords

HIV/AIDS Sub-Saharan Africa HIV prevention People living with HIV 

References

  1. 1.
    UNAIDS. The gap report. Geneva: Joint United Nations Programme on HIV/AIDS, 2014; 123.Google Scholar
  2. 2.
    UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS, 2014. Available at: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed October 26, 2015.
  3. 3.
    UNAIDS. Fast-tracking combination prevention. Towards reducing new HIV infections to fewer than 500,000 by 2020. Geneva: Joint United Nations Programme on HIV/AIDS. 2015.Google Scholar
  4. 4.
    UNAIDS and GNP + . Positive health, dignity, and prevention: operational guidelines. Geneva and Amsterdam: Joint United Nations Programme on HIV/AIDS and Global Network of People Living with HIV, 2013. Available at: http://www.gnpplus.net/assets/positive_health_dignity_and_prevention_operational_guidelines_-_unaids_gnp_2013.pdf. Accessed November 10, 2015.
  5. 5.
    Medley A, Bachanas P, Grillo M, Hasen N, Amanyeiwe U. Integrating prevention interventions for people living with HIV into care and treatment programs: a systematic review of the evidence. JAIDS. 2015;68(suppl 3):S286–96.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20:143–57.CrossRefPubMedGoogle Scholar
  7. 7.
    Kennedy CE, Medley AM, Sweat MD, O’Reilly KR. Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bull World Health Organ. 2010;88:615–23.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Saleh-Onoya D, Reddy P, Ruiter R, Sifunda S, Wingood G, van den Borne B. Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study. AIDS Care. 2009;21(7):817–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Wingood GM, DiClemente RJ, Mikhail I, et al. A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW program. JAIDS. 2004;37:S58–67.PubMedGoogle Scholar
  10. 10.
    Grossman D, Onono M, Newmann SJ, et al. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS. 2013;27(suppl 1):S77–85.CrossRefPubMedGoogle Scholar
  11. 11.
    Kirigia JM, Barry SP. Health challenges in Africa and the way forward. Int Arch Med. 2008;1:27.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    World Health Organization (WHO). Hormonal contraception and HIV: technical statement. Available at: http://www.who.int/reproductivehealth/publications/family_planning/rhr_12_8/en/index.html. Accessed on March 20, 2013.
  13. 13.
    Murray DM. Design and analysis of group-randomized trials. New York: Oxford University Press; 1998.Google Scholar
  14. 14.
    Kidder D, Bachanas P, Medley A, et al. HIV prevention in care and treatment settings: baseline risk behaviors among HIV patients in Kenya, Namibia, and Tanzania. PLoS ONE. 2013;8(2):e57215.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Babor T, Higgins-Biddle JC, Saunders JB, et al. The alcohol use disorders identification test: guidelines for use in primary care, 2nd edn. WHO, 2001. Available at: http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf. Accessed on January 20, 2011.
  16. 16.
    Kalichman SC, Simbayi LC, Jooste S, Cain D, Cherry C. Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa. Psychol Addit Behav. 2006;20:298–304.CrossRefGoogle Scholar
  17. 17.
    Luchters S, Geibel S, Syengo M, Lango D, King’ola N, Temmerman M, Chersich MF. Use of AUDIT and measures of drinking frequency and patterns to detect associations between alcohol and sexual behavior in male sex workers in Kenya. BMC Public Health. 2011;11:384–92.Google Scholar
  18. 18.
    Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use, and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16:2101–18.CrossRefPubMedGoogle Scholar
  19. 19.
    Zetola NM, Modongo C, Kip EC, Gross R, Bisson GP, Collman RG. Alcohol use and abuse among patients with multi-drug resistant tuberculosis in Botswana. Int J Tuberc Lung Dis. 2012;16:1529–34.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Church K, Kiweewa F, Dagupta A, Mwangome M, Mpandaguta E, Gomez-Olive FX, et al. A comparative analysis of national HIV policies in six African countries with generalized epidemics. Bull World Health Organ. 2015;93:457–67.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kakietek J, Geberselassie T, Manteuffel B, Ogungbemi K, Krivelyova A, Bausch S et al. It takes a village: community-based organizations and the availability and utilization of HIV/AIDS-related services in Nigeria. AIDS Care 25(suppl 1):78–87.Google Scholar
  22. 22.
    Hickey MD, Salmen CR, Omollo D, Mattah B, Fiorella KJ, Geng EH, et al. Implementation and operational research: pulling the network together. Quasi-experimental trial of a patient-defined support network intervention for promoting engagement in HIV care and medication adherence on Mfangano Island, Kenya. JAIDS. 2015;69(4):e127–34.Google Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA)  2016

Authors and Affiliations

  • Pamela Bachanas
    • 1
    Email author
  • Daniel Kidder
    • 1
  • Amy Medley
    • 1
  • Sherri L. Pals
    • 1
  • Deborah Carpenter
    • 2
  • Andrea Howard
    • 3
  • Gretchen Antelman
    • 4
  • Nicolas DeLuca
    • 5
  • Odylia Muhenje
    • 6
  • Muhsin Sheriff
    • 7
  • Geoffrey Somi
    • 8
  • Frieda Katuta
    • 9
  • Peter Cherutich
    • 10
  • Janet Moore
    • 1
  1. 1.Division of Global HIV/AIDSU.S. Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Global HIV/AIDSU.S. Centers for Disease Control and PreventionDar Es SalaamUnited Republic of Tanzania
  3. 3.ICAPColumbia UniversityNew YorkUSA
  4. 4.ICAP-TanzaniaColumbia UniversityDar Es SalaamUnited Republic of Tanzania
  5. 5.Division of Global HIV/AIDSU.S. Centers for Disease Control and PreventionWindhoekNamibia
  6. 6.Division of Global HIV/AIDSU.S. Centers for Disease Control and PreventionNairobiKenya
  7. 7.ICAP-KenyaColumbia UniversityNairobiKenya
  8. 8.Ministry of Health and Social WelfareDar Es SalaamUnited Republic of Tanzania
  9. 9.Ministry of Health and Social ServicesWindhoekNamibia
  10. 10.National AIDS/STD Control Programme (NASCOP)NairobiKenya

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