Gregson S., Adamson S., Papaya S., Mundondo J., Nyamukapa C.A., Mason P.R., Garnett G.P., Chandiwana S.K., Foster G., Anderson R.M.
Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe; Family AIDS Caring Trust, Mutare, Zimbabwe; Faculty of Health Sciences Research and Postgraduate Studies, University of Witwatersrand, Johannesburg, South Africa
Gregson, S., Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom, Biomedical Research and Training Institute, Harare, Zimbabwe; Adamson, S., Biomedical Research and Training Institute, Harare, Zimbabwe; Papaya, S., Family AIDS Caring Trust, Mutare, Zimbabwe; Mundondo, J., Family AIDS Caring Trust, Mutare, Zimbabwe; Nyamukapa, C.A., Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom, Biomedical Research and Training Institute, Harare, Zimbabwe; Mason, P.R., Biomedical Research and Training Institute, Harare, Zimbabwe; Garnett, G.P., Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom; Chandiwana, S.K., Biomedical Research and Training Institute, Harare, Zimbabwe, Faculty of Health Sciences Research and Postgraduate Studies, University of Witwatersrand, Johannesburg, South Africa; Foster, G., Family AIDS Caring Trust, Mutare, Zimbabwe; Anderson, R.M., Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom
Background: HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels. Methods and Findings: We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92-1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24-0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28-0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21-5.12). Conclusions: Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population subgroups. © 2007 Gregson et al.