title: Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa.
abstract: HIV testing uptake in South Africa is below optimal levels. Community mobilization (CM) may increase and sustain demand for HIV testing, however, little rigorous evidence exists regarding the effect of CM interventions on HIV testing and the mechanisms of action.
  
  
  
  We implemented a theory-driven CM intervention in 11 of 22 randomly-selected villages in rural Mpumalanga Province. Cross-sectional surveys including a community mobilization measure were conducted before (n = 1181) and after (n = 1175) a 2-year intervention (2012-2014). We assessed community-level intervention effects on reported HIV testing using multilevel logistic models. We used structural equation models to explore individual-level effects, specifically whether intervention assignment and individual intervention exposure were associated with HIV testing through community mobilization.
  
  
  
  Reported testing increased equally in both control and intervention sites: the intervention effect was null in primary analyses. However, the hypothesized pathway, CM, was associated with higher HIV testing in the intervention communities. Every standard deviation increase in village CM score was associated with increased odds of reported HIV testing in intervention village participants (odds ratio: 2.6, P = <0.001) but not control village participants (odds ratio: 1.2, P = 0.53). Structural equation models demonstrate that the intervention affected HIV testing uptake through the individual intervention exposure received and higher personal mobilization scores.
  
  
  
  There was no evidence of community-wide gains in HIV testing due to the intervention. However, a significant intervention effect on HIV testing was noted in residents who were personally exposed to the intervention and who evidenced higher community mobilization. Research is needed to understand whether CM interventions can be diffused within communities over time.
authors.affiliation: *Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA; †MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡School of Health, University of New England, Armidale, New South Wales, Australia; §Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; ‖Sonke Gender Justice, Cape Town, South Africa; ¶School of Public Health, University of Cape Town, South Africa; #Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; **Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and ††Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Lippman
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.forename: Catherine
authors.initials: C
authors.lastname: MacPhail
authors.forename: Dean
authors.initials: D
authors.lastname: Peacock
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.forename: Dumisani
authors.initials: D
authors.lastname: Rebombo
authors.forename: Rhian
authors.initials: R
authors.lastname: Twine
authors.forename: Amanda
authors.initials: A
authors.lastname: Selin
authors.forename: Hannah H
authors.initials: HH
authors.lastname: Leslie
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
mesh_terms: D000328:Adult; D003153:Community Health Services; D019058:Community Networks; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D006293:Health Promotion; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult