The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth.
BACKGROUND
HIV prevention among young people in southern Africa is a public health priority. There is little rigorous evidence of the effectiveness of different intervention approaches. We describe findings of a cluster randomized trial of a community-based, multicomponent HIV, and reproductive health intervention aimed at changing social norms for adolescents in rural Zimbabwe.


METHODS
Thirty rural communities were randomized to early or deferred implementation of the intervention in 2003. Impact was assessed in a representative survey of 18-22-year-olds after 4 years. Participants self-completed a questionnaire and gave a dried blood spot sample for HIV and herpes simplex virus-2 (HSV-2) antibody testing. Young women had a urinary pregnancy test. Analyses were by intention-to-treat and were adjusted for clustering.


RESULTS
Four thousand six hundred and eighty-four, 18-22-year-olds participated in the survey (97.1% of eligible candidates, 55.5% women). Just over 40% had been exposed to at least 10 intervention sessions. There were modest improvements in knowledge and attitudes among young men and women in intervention communities, but no impact on self-reported sexual behavior. There was no impact of the intervention on prevalence of HIV or HSV-2 or current pregnancy. Women in intervention communities were less likely to report ever having been pregnant.


CONCLUSIONS
Despite an impact on knowledge, some attitudes, and reported pregnancy, there was no impact of this intervention on HIV or HSV-2 prevalence, further evidence that behavioral interventions alone are unlikely to be sufficient to reverse the HIV epidemic. The challenge remains to find effective HIV prevention approaches for young people in the face of continued and unacceptably high HIV incidence, particularly among young women.
Cowan
Frances M
FM
Centre for Sexual Health and HIV Research, University College London Medical School, London, UK. francesmcowan@yahoo.co.uk
Pascoe
Sophie J S
SJ
Langhaug
Lisa F
LF
Mavhu
Webster
W
Chidiya
Samson
S
Jaffar
Shabbar
S
Mbizvo
Michael T
MT
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 / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006561:Herpes Simplex / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011247:Pregnancy; D012423:Rural Health; D012424:Rural Population; D012736:Sex Education / Q000379:methods; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology