The University of Southampton
University of Southampton Institutional Repository

Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study

Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study
Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study
BACKGROUND: In developing countries, most people infected with HIV do not know their infection status. We aimed to assess whether HIV testing could be increased by combination of community mobilisation, mobile community-based voluntary counselling and testing (VCT), and support after testing.

METHODS: Project Accept is underway in ten communities in Tanzania, eight in Zimbabwe, and 14 in Thailand. Communities at each site were paired according to similar demographic and environmental characteristics, and one community from each pair was randomly assigned to receive standard clinic-based VCT (SVCT), and the other community was assigned to receive community-based VCT (CBVCT) plus access to SVCT. Randomisation and assignment of communities to intervention groups was done by the statistics centre by computer; no one was masked to treatment assignment because the interventions were community based. Intervention was provided for about 3 years (2006-09). The primary endpoint of HIV incidence is pending completion of assessments after the intervention. In this interim analysis, we examined the secondary endpoint of uptake in HIV testing, differences in characteristics of clients receiving their first HIV test, and repeat testing. Analyses were limited to clients aged 16-32 years. This study is registered with ClinicalTrials.gov, number NCT00203749.

FINDINGS: The proportion of clients receiving their first HIV test during the study was higher in CBVCT communities than in SVCT communities in Tanzania (2341 [37%] of 6250 vs 579 [9%] of 6733), Zimbabwe (5437 [51%] of 10,700 vs 602 [5%] of 12,150), and Thailand (7802 [69%] of 11,290 vs 2319 [23%] 10,033). The mean difference in the proportion of clients receiving HIV testing between CBVCT and SVCT communities was 40·2% (95% CI 15·8-64·7; p=0·019) across three community pairs (one per country). HIV prevalence was higher in SVCT communities than in CBVCT communities, but CBVCT detected almost four times more HIV cases than did SVCT across the three study sites (952 vs 264; p=0·003). Repeat HIV testing in CBVCT communities increased in all sites to reach 28% of all those testing for HIV by the end of the intervention period.

INTERPRETATION: CBVCT should be considered as a viable intervention to increase detection of HIV infection, especially in regions with restricted access to clinic-based VCT and support services after testing.
1473-3099
525-832
Sweat, M.
08cee978-dd00-4299-8d9b-e8884cc68e01
Morin, S.
dde3e0b9-c7a6-40b5-9b60-35b13f8cc9a4
Celentano, D.
08608f4f-53fb-4e9c-8073-3701ee2e5d2e
Mulawa, M.
6fd8f212-cccb-41b6-8d71-3f4aa61ddd9d
Singh, B.
f749506c-fb43-4def-b011-39cf84bc6495
Mbwambo, J.
747523cd-5de5-4e46-b64e-b72774152d93
Kawichai, S.
e197f95a-2b9f-4bb5-b4ba-8dbea3451680
Chingono, A.
62deb406-eb02-48af-91cd-5a852dbe35de
Khumalo-Sakutukwa, G.
283fc24b-ea5e-4d76-a646-3b251809ec8b
Gray, G.
6fa4e222-80ae-413c-b898-bcc07085c1c8
Richter, L.
1b3d8141-a6e5-46a5-a0ed-3af79028483b
Kulich, M.
9155f1ad-a667-4081-ae5d-e3afd76d55c6
Sadowski, A.
ad772983-3559-4ff8-84c6-7dcce3edb144
Coates, T.
da1e02f7-50b9-493c-b7f8-f0324c79f637
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Project Accept study team, None
c8c57611-edc4-4504-b37d-824ca3d67ed3
Sweat, M.
08cee978-dd00-4299-8d9b-e8884cc68e01
Morin, S.
dde3e0b9-c7a6-40b5-9b60-35b13f8cc9a4
Celentano, D.
08608f4f-53fb-4e9c-8073-3701ee2e5d2e
Mulawa, M.
6fd8f212-cccb-41b6-8d71-3f4aa61ddd9d
Singh, B.
f749506c-fb43-4def-b011-39cf84bc6495
Mbwambo, J.
747523cd-5de5-4e46-b64e-b72774152d93
Kawichai, S.
e197f95a-2b9f-4bb5-b4ba-8dbea3451680
Chingono, A.
62deb406-eb02-48af-91cd-5a852dbe35de
Khumalo-Sakutukwa, G.
283fc24b-ea5e-4d76-a646-3b251809ec8b
Gray, G.
6fa4e222-80ae-413c-b898-bcc07085c1c8
Richter, L.
1b3d8141-a6e5-46a5-a0ed-3af79028483b
Kulich, M.
9155f1ad-a667-4081-ae5d-e3afd76d55c6
Sadowski, A.
ad772983-3559-4ff8-84c6-7dcce3edb144
Coates, T.
da1e02f7-50b9-493c-b7f8-f0324c79f637
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Project Accept study team, None
c8c57611-edc4-4504-b37d-824ca3d67ed3

Sweat, M., Morin, S., Celentano, D., Mulawa, M., Singh, B., Mbwambo, J., Kawichai, S., Chingono, A., Khumalo-Sakutukwa, G., Gray, G., Richter, L., Kulich, M., Sadowski, A., Coates, T., McGrath, N. and Project Accept study team, None (2011) Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. The Lancet Infectious Diseases, 11 (7), 525-832. (doi:10.1016/S1473-3099(11)70060-3). (PMID:21546309)

Record type: Article

Abstract

BACKGROUND: In developing countries, most people infected with HIV do not know their infection status. We aimed to assess whether HIV testing could be increased by combination of community mobilisation, mobile community-based voluntary counselling and testing (VCT), and support after testing.

METHODS: Project Accept is underway in ten communities in Tanzania, eight in Zimbabwe, and 14 in Thailand. Communities at each site were paired according to similar demographic and environmental characteristics, and one community from each pair was randomly assigned to receive standard clinic-based VCT (SVCT), and the other community was assigned to receive community-based VCT (CBVCT) plus access to SVCT. Randomisation and assignment of communities to intervention groups was done by the statistics centre by computer; no one was masked to treatment assignment because the interventions were community based. Intervention was provided for about 3 years (2006-09). The primary endpoint of HIV incidence is pending completion of assessments after the intervention. In this interim analysis, we examined the secondary endpoint of uptake in HIV testing, differences in characteristics of clients receiving their first HIV test, and repeat testing. Analyses were limited to clients aged 16-32 years. This study is registered with ClinicalTrials.gov, number NCT00203749.

FINDINGS: The proportion of clients receiving their first HIV test during the study was higher in CBVCT communities than in SVCT communities in Tanzania (2341 [37%] of 6250 vs 579 [9%] of 6733), Zimbabwe (5437 [51%] of 10,700 vs 602 [5%] of 12,150), and Thailand (7802 [69%] of 11,290 vs 2319 [23%] 10,033). The mean difference in the proportion of clients receiving HIV testing between CBVCT and SVCT communities was 40·2% (95% CI 15·8-64·7; p=0·019) across three community pairs (one per country). HIV prevalence was higher in SVCT communities than in CBVCT communities, but CBVCT detected almost four times more HIV cases than did SVCT across the three study sites (952 vs 264; p=0·003). Repeat HIV testing in CBVCT communities increased in all sites to reach 28% of all those testing for HIV by the end of the intervention period.

INTERPRETATION: CBVCT should be considered as a viable intervention to increase detection of HIV infection, especially in regions with restricted access to clinic-based VCT and support services after testing.

Text
community-based intervention to increase HIV testing.pdf - Other
Download (481kB)

More information

e-pub ahead of print date: 3 May 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 350258
URI: http://eprints.soton.ac.uk/id/eprint/350258
ISSN: 1473-3099
PURE UUID: b0a6fed6-0f0e-460a-860a-93bde47fa9f4
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 20 Mar 2013 14:08
Last modified: 15 Mar 2024 03:46

Export record

Altmetrics

Contributors

Author: M. Sweat
Author: S. Morin
Author: D. Celentano
Author: M. Mulawa
Author: B. Singh
Author: J. Mbwambo
Author: S. Kawichai
Author: A. Chingono
Author: G. Khumalo-Sakutukwa
Author: G. Gray
Author: L. Richter
Author: M. Kulich
Author: A. Sadowski
Author: T. Coates
Author: N. McGrath ORCID iD
Author: None Project Accept study team

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×