A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial
Abstract Introduction Optimizing HIV prevention may require structured approaches for providing client‐centred choices as well as community‐based entry points and delivery. We evaluated the effect of a dynamic choice model for HIV prevention, delivered by community health workers (CHWs) with clinici...
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-12-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26195 |
| _version_ | 1827397791769427968 |
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| author | Elijah R. Kakande James Ayieko Helen Sunday Edith Biira Marilyn Nyabuti George Agengo Jane Kabami Colette Aoko Hellen N. Atuhaire Norton Sang Asiphas Owaranganise Janice Litunya Erick W. Mugoma Gabriel Chamie James Peng John Schrom Melanie C. Bacon Moses R. Kamya Diane V. Havlir Maya L. Petersen Laura B. Balzer for the SEARCH Study Team |
| author_facet | Elijah R. Kakande James Ayieko Helen Sunday Edith Biira Marilyn Nyabuti George Agengo Jane Kabami Colette Aoko Hellen N. Atuhaire Norton Sang Asiphas Owaranganise Janice Litunya Erick W. Mugoma Gabriel Chamie James Peng John Schrom Melanie C. Bacon Moses R. Kamya Diane V. Havlir Maya L. Petersen Laura B. Balzer for the SEARCH Study Team |
| author_sort | Elijah R. Kakande |
| collection | DOAJ |
| description | Abstract Introduction Optimizing HIV prevention may require structured approaches for providing client‐centred choices as well as community‐based entry points and delivery. We evaluated the effect of a dynamic choice model for HIV prevention, delivered by community health workers (CHWs) with clinician support, on the use of biomedical prevention among persons at risk of HIV in rural East Africa. Methods We conducted a cluster randomized trial among persons (≥15 years) with current or anticipated HIV risk in 16 villages in Uganda and Kenya (SEARCH; NCT04810650). The intervention was a client‐centred HIV prevention model, including (1) structured client choice of product (pre‐exposure prophylaxis [PrEP] or post‐exposure prophylaxis [PEP]), service location (clinic or out‐of‐clinic) and HIV testing modality (self‐test or rapid test), with the ability to switch over time; (2) a structured assessment of patient barriers and development of a personalized support plan; and (3) phone access to a clinician 24/7. The intervention was delivered by CHWs and supported by clinicians who oversaw PrEP and PEP initiation and monitoring. Participants in control villages were referred to local health facilities for HIV prevention services, delivered by Ministry of Health staff. The primary outcome was biomedical prevention coverage: a proportion of 48‐week follow‐up with self‐reported PrEP or PEP use. Results From May to July 2021, we enrolled 429 people (212 intervention; 217 control): 57% women and 35% aged 15–24 years. Among intervention participants, 58% chose PrEP and 58% chose PEP at least once over follow‐up; self‐testing increased from 52% (baseline) to 71% (week 48); ≥98% chose out‐of‐facility service delivery. Among 413 (96%) participants with the primary outcome ascertained, average biomedical prevention coverage was 28.0% in the intervention versus 0.5% in the control: a difference of 27.5% (95% CI: 23.0–31.9%, p<0.001). Impact was larger during periods of self‐reported HIV risk: 36.6% coverage in intervention versus 0.9% in control, a difference of 35.7% (95% CI: 27.5–43.9, p<0.001). Intervention effects were seen across subgroups defined by sex, age group and alcohol use. Conclusions A client‐centred dynamic choice HIV prevention intervention, including the option to switch between products and CHW‐based delivery in the community, increased biomedical prevention coverage by 27.5%. However, substantial person‐time at risk of HIV remained uncovered. |
| first_indexed | 2024-03-08T19:17:47Z |
| format | Article |
| id | doaj.art-a39f962d4db4432e84ecb4488bafb879 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-08T19:17:47Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-a39f962d4db4432e84ecb4488bafb8792023-12-27T05:20:28ZengWileyJournal of the International AIDS Society1758-26522023-12-012612n/an/a10.1002/jia2.26195A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trialElijah R. Kakande0James Ayieko1Helen Sunday2Edith Biira3Marilyn Nyabuti4George Agengo5Jane Kabami6Colette Aoko7Hellen N. Atuhaire8Norton Sang9Asiphas Owaranganise10Janice Litunya11Erick W. Mugoma12Gabriel Chamie13James Peng14John Schrom15Melanie C. Bacon16Moses R. Kamya17Diane V. Havlir18Maya L. Petersen19Laura B. Balzer20for the SEARCH Study TeamInfectious Diseases Research Collaboration Kampala UgandaKenya Medical Research Institute Nairobi KenyaInfectious Diseases Research Collaboration Kampala UgandaInfectious Diseases Research Collaboration Kampala UgandaKenya Medical Research Institute Nairobi KenyaKenya Medical Research Institute Nairobi KenyaInfectious Diseases Research Collaboration Kampala UgandaKenya Medical Research Institute Nairobi KenyaInfectious Diseases Research Collaboration Kampala UgandaKenya Medical Research Institute Nairobi KenyaInfectious Diseases Research Collaboration Kampala UgandaKenya Medical Research Institute Nairobi KenyaGlobal Programs for Research & Training Nairobi KenyaDivision of HIV Infectious Diseases, and Global Medicine University of California San Francisco San Francisco California USADepartment of Biostatistics University of Washington Seattle Washington USADivision of HIV Infectious Diseases, and Global Medicine University of California San Francisco San Francisco California USADepartment of Health and Human Services National Institute of Health Bethesda Maryland USAInfectious Diseases Research Collaboration Kampala UgandaDivision of HIV Infectious Diseases, and Global Medicine University of California San Francisco San Francisco California USADivision of Biostatistics University of California Berkeley Berkeley California USADivision of Biostatistics University of California Berkeley Berkeley California USAAbstract Introduction Optimizing HIV prevention may require structured approaches for providing client‐centred choices as well as community‐based entry points and delivery. We evaluated the effect of a dynamic choice model for HIV prevention, delivered by community health workers (CHWs) with clinician support, on the use of biomedical prevention among persons at risk of HIV in rural East Africa. Methods We conducted a cluster randomized trial among persons (≥15 years) with current or anticipated HIV risk in 16 villages in Uganda and Kenya (SEARCH; NCT04810650). The intervention was a client‐centred HIV prevention model, including (1) structured client choice of product (pre‐exposure prophylaxis [PrEP] or post‐exposure prophylaxis [PEP]), service location (clinic or out‐of‐clinic) and HIV testing modality (self‐test or rapid test), with the ability to switch over time; (2) a structured assessment of patient barriers and development of a personalized support plan; and (3) phone access to a clinician 24/7. The intervention was delivered by CHWs and supported by clinicians who oversaw PrEP and PEP initiation and monitoring. Participants in control villages were referred to local health facilities for HIV prevention services, delivered by Ministry of Health staff. The primary outcome was biomedical prevention coverage: a proportion of 48‐week follow‐up with self‐reported PrEP or PEP use. Results From May to July 2021, we enrolled 429 people (212 intervention; 217 control): 57% women and 35% aged 15–24 years. Among intervention participants, 58% chose PrEP and 58% chose PEP at least once over follow‐up; self‐testing increased from 52% (baseline) to 71% (week 48); ≥98% chose out‐of‐facility service delivery. Among 413 (96%) participants with the primary outcome ascertained, average biomedical prevention coverage was 28.0% in the intervention versus 0.5% in the control: a difference of 27.5% (95% CI: 23.0–31.9%, p<0.001). Impact was larger during periods of self‐reported HIV risk: 36.6% coverage in intervention versus 0.9% in control, a difference of 35.7% (95% CI: 27.5–43.9, p<0.001). Intervention effects were seen across subgroups defined by sex, age group and alcohol use. Conclusions A client‐centred dynamic choice HIV prevention intervention, including the option to switch between products and CHW‐based delivery in the community, increased biomedical prevention coverage by 27.5%. However, substantial person‐time at risk of HIV remained uncovered.https://doi.org/10.1002/jia2.26195client‐centredcommunity health workerdynamic choicepre‐exposure prophylaxispost‐exposure prophylaxisvillage health team |
| spellingShingle | Elijah R. Kakande James Ayieko Helen Sunday Edith Biira Marilyn Nyabuti George Agengo Jane Kabami Colette Aoko Hellen N. Atuhaire Norton Sang Asiphas Owaranganise Janice Litunya Erick W. Mugoma Gabriel Chamie James Peng John Schrom Melanie C. Bacon Moses R. Kamya Diane V. Havlir Maya L. Petersen Laura B. Balzer for the SEARCH Study Team A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial Journal of the International AIDS Society client‐centred community health worker dynamic choice pre‐exposure prophylaxis post‐exposure prophylaxis village health team |
| title | A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial |
| title_full | A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial |
| title_fullStr | A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial |
| title_full_unstemmed | A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial |
| title_short | A community‐based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial |
| title_sort | community based dynamic choice model for hiv prevention improves prep and pep coverage in rural uganda and kenya a cluster randomized trial |
| topic | client‐centred community health worker dynamic choice pre‐exposure prophylaxis post‐exposure prophylaxis village health team |
| url | https://doi.org/10.1002/jia2.26195 |
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