Simon Gregson|Saina Adamson|Spiwe Papaya|Jephias Mundondo|Constance Nyamukapa|Peter R. Mason|Geoffrey P. Garnett|S.K. Chandiwana|Geoff Foster|Roy M. Anderson
Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe
Imperial College London|Biomedical Research and Training Institute|Biomedical Research and Training Institute|Family Aids Caring Trust|Family Aids Caring Trust|Imperial College London|Biomedical Research and Training Institute|Biomedical Research and Training Institute|Imperial College London|University of the Witwatersrand|Biomedical Research and Training Institute|Family Aids Caring Trust|Imperial College London
hiv1 control subsaharan africa requires costeffective sustainable programmes promote behaviour change reduce cofactor sexually transmitted infections stis population individual levelswe measured feasibility communitybased peer education free condom distribution incomegenerating projects clinicbased sti treatment counselling services evaluated impact incidence hiv1 measured 3y period clusterrandomised controlled trial eastern zimbabwe analysis primary outcomes intentiontotreat basis incomegenerating projects proved impossible implement prevailing economic climate despite greater programme activity knowledge intervention communities incidence rate ratio hiv1 127 95 confidence interval ci 092175 compared control communities evidence found reduced incidence selfreported sti symptoms highrisk sexual behaviour intervention communities males attended programme meetings lower hiv1 incidence incidence rate ratio 048 95 ci 024098 fewer men attended programme meetings reported unprotected sex casual partners odds ratio 045 95 ci 028075 male sti patients intervention communities reported cessation symptoms odds ratio 249 95 ci 121512integrated peer education condom distribution syndromic sti management reduce populationlevel hiv1 incidence declining epidemic despite reducing hiv1 incidence immediate male target group results highlight need assess communitylevel impact interventions effective amongst targeted population subgroups