title: Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania.
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.
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA. pbachanas@cdc.gov.
authors.forename: Pamela
authors.initials: P
authors.lastname: Bachanas
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kidder
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Medley
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Pals
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Dar Es Salaam, United Republic of Tanzania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Carpenter
authors.affiliation: ICAP, Columbia University, New York, NY, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Howard
authors.affiliation: ICAP-Tanzania, Columbia University, Dar Es Salaam, United Republic of Tanzania.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Antelman
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.
authors.forename: Nicolas
authors.initials: N
authors.lastname: DeLuca
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Odylia
authors.initials: O
authors.lastname: Muhenje
authors.affiliation: ICAP-Kenya, Columbia University, Nairobi, Kenya.
authors.forename: Muhsin
authors.initials: M
authors.lastname: Sheriff
authors.affiliation: Ministry of Health and Social Welfare, Dar Es Salaam, United Republic of Tanzania.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Somi
authors.affiliation: Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Frieda
authors.initials: F
authors.lastname: Katuta
authors.affiliation: National AIDS/STD Control Programme (NASCOP), Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E04, Atlanta, GA, 30333, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D016000:Cluster Analysis; D003695:Delivery of Health Care; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009276:Namibia; D010043:Outcome and Process Assessment, Health Care; D021841:Safe Sex; D012747:Sexual Partners; D013636:Tanzania; D047568:Unsafe Sex; D055815:Young Adult
keywords: HIV prevention; HIV/AIDS; People living with HIV; Sub-Saharan Africa