title: HIV prevention in favour of the choice-disabled in southern Africa: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Most HIV prevention strategies assume beneficiaries can act on their prevention decisions. But some people are unable to do so. They are 'choice-disabled'. Economic and educational interventions can reduce sexual violence, but there is less evidence that they can reduce HIV. There is little research on complex interventions in HIV prevention, yet all countries in southern Africa implement combination prevention programmes.
  
  
  METHODS
  The primary objective is to reduce HIV infections among women aged 15 to 29 years. Secondary objectives are reduction in gender violence and improvement in HIV-related knowledge, attitudes and practices among youth aged 15 to 29 years.A random sample of 77 census enumeration areas in three countries (Botswana, Namibia and Swaziland) was allocated randomly to three interventions, alone or in combination, in a factorial design stratified by country, HIV rates (above or below average for country), and urban/rural location. A baseline survey of youth aged 15 to 29 years provided cluster specific rates of HIV. All clusters continue existing prevention efforts and have a baseline and follow-up survey. Cluster is the unit of allocation, intervention and analysis, using generalised estimating equations, on an intention-to-treat basis.One intervention discusses evidence about choice disability with local HIV prevention services, to help them to serve the choice-disabled. Another discusses an eight-episode audio-docudrama with community groups, of all ages and both sexes, to generate endogenous strategies to reduce gender violence and develop an enabling environment. A third supports groups of women aged 18 to 25 years to build self-esteem and life skills and to set up small enterprises to generate income.A survey in all clusters after 3 years will measure outcomes, with interviewers unaware of group assignment of the clusters. The primary outcome is HIV infection in women aged 15 to 29 years. Secondary outcomes in youth aged 15 to 29 years are gender violence and protective knowledge, attitudes, subjective norms, intention to change, agency, discussion of prevention and practices related to HIV and gender violence.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN28557578.
authors.affiliation: Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Calle Pino, El Roble, Acapulco, Mexico. andersson@ciet.org.
authors.forename: Neil
authors.initials: N
authors.lastname: Andersson
authors.forename: Anne
authors.initials: A
authors.lastname: Cockcroft
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Nobantu
authors.initials: N
authors.lastname: Marokoane
authors.forename: Ditiro
authors.initials: D
authors.lastname: Laetsang
authors.forename: Mokgweetsi
authors.initials: M
authors.lastname: Masisi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000353:Africa, Southern; D044383:Black People / Q000523:psychology*; D002755:Choice Behavior; D017579:Domestic Violence / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D011314:Preventive Health Services / Q000379:methods*; D012107:Research Design; D012742:Sex Offenses / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D011477:Sex Work; D012725:Sexual Behavior; D012944:Social Support; D013997:Time Factors; D047568:Unsafe Sex; D055815:Young Adult