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.
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).


CONCLUSIONS
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.
Cowan
Frances M
FM
Centre for Sexual Health and HIV Research, University College London, London, UK. francesmcowan@yahoo.co.zw
Pascoe
Sophie J S
SJ
Langhaug
Lisa F
LF
Dirawo
Jeffrey
J
Chidiya
Samson
S
Jaffar
Shabbar
S
Mbizvo
Michael
M
Stephenson
Judith M
JM
Johnson
Anne M
AM
Power
Robert M
RM
Woelk
Godfrey
G
Hayes
Richard J
RJ
D000293:Adolescent; D016000:Cluster Analysis; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D015497:HIV-1; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006561:Herpes Simplex / Q000453:epidemiology / Q000517:prevention & control*; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D011247:Pregnancy; D012423:Rural Health / Q000592:standards*; D012572:School Health Services; D012736:Sex Education / Q000592:standards; D012725:Sexual Behavior / Q000523:psychology*; D055815:Young Adult; D015030:Zimbabwe