Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

• Published in: AIDS and behavior Vol. 20; no. 9; pp. 2110 - 2118
• Main Authors: Bachanas, Pamela, Kidder, Daniel, Medley, Amy, Pals, Sherri L., Carpenter, Deborah, Howard, Andrea, Antelman, Gretchen, DeLuca, Nicolas, Muhenje, Odylia, Sheriff, Muhsin, Somi, Geoffrey, Katuta, Frieda, Cherutich, Peter, Moore, Janet
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2016; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Ambulatory Care Facilities; Behavior modification; Birth control; Clinics; Cluster Analysis; Contraception; Delivery of Health Care; Disease prevention; Family planning; Feasibility Studies; Female; Health behavior; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Humans; Infectious Diseases; Intervention; Kenya; Lentivirus; Male; Medication Adherence; Medicine; Medicine & Public Health; Middle Aged; Namibia; Operations research; Original Paper; Outcome and Process Assessment (Health Care); Patients; Prevention; Public Health; Randomization; Regression models; Safe Sex; Self disclosure; Sex; Sexual Partners; Sexually transmitted diseases; STD; Tanzania; Unsafe Sex; Young Adult; Kenya; Namibia; Tanzania; ISW, Tanzania; HIV/AIDS; HIV prevention; People living with HIV; Sub-Saharan Africa
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-016-1349-2

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.