Deanna Kerrigan1, Jessie Mbwambo2, Samuel Likindikoki2, Wendy Davis1, Andrea Mantsios1, S Wilson Beckham3, Anna Leddy4, Catherine Shembilu2, Ard Mwampashi2, Said Aboud5, Noya Galai6,7. 1. Department of Sociology, Center on Health, Risk and Society, American University, Washington, DC. 2. Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 3. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4. Department of Medicine, University of California at San Francisco, San Francisco, CA. 5. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 6. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 7. University of Haifa, Haifa, Israel.
Abstract
OBJECTIVE: To determine the impact of a community empowerment model of combination HIV prevention (Project Shikamana) among female sex workers (FSW) in Iringa, Tanzania. METHODS: We conducted a 2-community randomized trial. Intervention elements included the following: (1) Community-led drop-in center and mobilization activities; (2) venue-based peer education, condom distribution, and HIV testing; (3) peer service navigation; (4) provider sensitivity trainings; and (5) SMS reminders. We used time-location sampling to enroll 496 FSW and conducted a survey and blood draws to screen for HIV and assess viral load at 0 and 18 months. We conducted an intent-to-treat analysis using logistic and Poisson regression and inverse probability weighting for primary outcomes. RESULTS: The analysis included 171 HIV-positive and 216 HIV-negative FSW who completed baseline and 18-month study visits. Participants in the intervention were significantly less likely to become infected with HIV at 18-month follow-up (RR 0.38; P = 0.047), with an HIV incidence of 5.0% in the intervention vs. 10.4% control. Decreases in inconsistent condom use over time were significantly greater in the intervention (72.0%-43.6%) vs. control (68.8%-54.0%; RR 0.81, P = 0.042). At follow-up, we observed significant differences in behavioral HIV care continuum outcomes, and positive, but nonsignificant, increases in viral suppression (40.0%-50.6%) in the intervention vs. control (35.9%-47.4%). There was a strong association of between higher intervention exposure and HIV outcomes including viral suppression. CONCLUSIONS:Project Shikamana is the first trial of community empowerment-based combination prevention among FSW in Africa to show a significant reduction in HIV incidence warranting its broader implementation and evaluation.
RCT Entities:
OBJECTIVE: To determine the impact of a community empowerment model of combination HIV prevention (Project Shikamana) among female sex workers (FSW) in Iringa, Tanzania. METHODS: We conducted a 2-community randomized trial. Intervention elements included the following: (1) Community-led drop-in center and mobilization activities; (2) venue-based peer education, condom distribution, and HIV testing; (3) peer service navigation; (4) provider sensitivity trainings; and (5) SMS reminders. We used time-location sampling to enroll 496 FSW and conducted a survey and blood draws to screen for HIV and assess viral load at 0 and 18 months. We conducted an intent-to-treat analysis using logistic and Poisson regression and inverse probability weighting for primary outcomes. RESULTS: The analysis included 171 HIV-positive and 216 HIV-negative FSW who completed baseline and 18-month study visits. Participants in the intervention were significantly less likely to become infected with HIV at 18-month follow-up (RR 0.38; P = 0.047), with an HIV incidence of 5.0% in the intervention vs. 10.4% control. Decreases in inconsistent condom use over time were significantly greater in the intervention (72.0%-43.6%) vs. control (68.8%-54.0%; RR 0.81, P = 0.042). At follow-up, we observed significant differences in behavioral HIV care continuum outcomes, and positive, but nonsignificant, increases in viral suppression (40.0%-50.6%) in the intervention vs. control (35.9%-47.4%). There was a strong association of between higher intervention exposure and HIV outcomes including viral suppression. CONCLUSIONS: Project Shikamana is the first trial of community empowerment-based combination prevention among FSW in Africa to show a significant reduction in HIV incidence warranting its broader implementation and evaluation.
Authors: Anna M Leddy; Andrea Mantsios; Wendy Davis; Ohvia Muraleetharan; Catherine Shembilu; Ard Mwampashi; S Wilson Beckham; Noya Galai; Samuel Likindikoki; Jessie Mbwambo; Deanna Kerrigan Journal: Cult Health Sex Date: 2019-09-09
Authors: Zoé Mistrale Hendrickson; Anna M Leddy; Noya Galai; S Wilson Beckham; Wendy Davis; Jessie K Mbwambo; Samuel Likindikoki; Deanna L Kerrigan Journal: PLoS One Date: 2021-06-03 Impact factor: 3.240
Authors: S Wilson Beckham; Melissa Stockton; Noya Galai; Wendy Davis; Jessie Mwambo; Samuel Likindikoki; Deanna Kerrigan Journal: BMC Public Health Date: 2021-07-12 Impact factor: 3.295
Authors: Marie A Brault; Donna Spiegelman; James Hargreaves; Denis Nash; Sten H Vermund Journal: J Acquir Immune Defic Syndr Date: 2019-12-01 Impact factor: 3.731