HIV prevention among youth: A randomized controlled trial of voluntary counseling and testing for HIV and male condom distribution in rural Kenya

Esther Duflo, Pascaline Dupas, Thomas Ginn, Grace Makana Barasa, Moses Baraza, Victor Pouliquen, Vandana Sharma, Esther Duflo, Pascaline Dupas, Thomas Ginn, Grace Makana Barasa, Moses Baraza, Victor Pouliquen, Vandana Sharma

Abstract

Objective: Voluntary Counseling and Testing for HIV (VCT) and increasing access to male condoms are common strategies to respond to the HIV/AIDS pandemic. Using biological and behavioral outcomes, we compared programs to increase access to VCT, male condoms or both among youth in Western Kenya with the standard available HIV prevention services within this setting.

Design: A four arm, unblinded randomized controlled trial.

Methods: The sample includes 10,245 youth aged 17 to 24 randomly assigned to receive community-based VCT, 150 male condoms, both VCT and condoms, or neither program. All had access to standard HIV services available within their communities. Surveys and blood samples for HSV-2 testing were collected at baseline (2009-2010) and at follow up (2011-2013). VCT was offered to all participants at follow up. HSV-2 prevalence, the primary outcome, was assessed using weighted logistic regressions in an intention-to-treat analysis.

Results: For the 7,565 respondents surveyed at follow up, (effective tracking rate = 91%), the weighted HSV-2 prevalence was similar across groups (control group = 10.8%, condoms only group = 9.1%, VCT only group = 10.2%, VCT and condoms group = 11.5%). None of the interventions significantly reduced HSV-2 prevalence; the adjusted odds ratios were 0.87 (95% CI: 0.61-1.25) for condoms only, 0.94 (95% CI: 0.64-1.38) for VCT only, and 1.12 (95% CI: 0.79-1.58) for both interventions. The VCT intervention significantly increased HIV testing (adj OR: 3.54, 95% CI: 2.32-5.41 for VCT only, and adj OR: 5.52, 95% CI: 3.90-7.81 for condoms and VCT group). There were no statistically significant effects on risk of HIV, or on other behavioral or knowledge outcomes including self-reported pregnancy rates.

Conclusion: This study suggests that systematic community-based VCT campaigns (in addition to VCT availability at local health clinics) and condom distribution are unlikely on their own to significantly reduce the prevalence of HSV-2 among youth.

Trial registration: ClinicalTrials.gov NCT03868644.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Participant flow diagram.
Fig 1. Participant flow diagram.
Note: "bd" gives the number of respondents for whom a blood draw was successfully taken. a: the effective final tracking rate combines regular and intensive tracking rates, and provides an estimate of the share of the total sample for which the data are representative.

References

    1. UNAIDS. Fact Sheet 2018. Available from: [Cited 11 June 2019].
    1. UNAIDS. AIDS Info New: HIV Infections. Available from [Cited Jun 11 2019].
    1. UNAIDS. Women and HIV: A Spotlight on Adolescent Girls and Young Women. 2019.
    1. UNAIDS. UNAIDS Gap Report 2014. 2015.
    1. Oberzaucher N, Baggaley R. HIV Voluntary Counselling and Testing: A Gateway to Prevention and Care. Five case studies related to the prevention of mother-to-child transmission of HIV, tuberculosis, young people, and reaching general population groups 2002. UNAIDS.
    1. De Cock KM, Marum E, Mbori-Ngacha D. A serostatus-based approach to HIV/AIDS prevention and care in Africa. Lancet. 2003; 362(9398): 1847–1849. 10.1016/S0140-6736(03)14906-9
    1. WHO. Scaling-up HIV testing and counselling services: a toolkit for program managers. 2004. Available from: [Cited 21 August 2017].
    1. Arthur G, Nduba V, Forsythe S, Mutemi R, Odhiambo J, Gilks C. Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya. Sex Transm Infect. 2007; 83(7):541–6. 10.1136/sti.2007.026732
    1. Matambo R, Dauya E, Mutswanga J, Makanza E, Chandiwana S, Mason PR, et al. Voluntary counseling and testing by nurse counselors: what is the role of routine repeated testing after a negative result? Clin Infect Dis. 2006; 42(4):569–71 10.1086/499954
    1. Cawley C, Wringe A, Slaymaker E, Todd J, Michael D, Kumugola Y, et al. The impact of voluntary counselling and testing services on sexual behaviour change and HIV incidence: observations from a cohort study in rural Tanzania. BMC infectious diseases 2014; 14(159).
    1. Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. The Cochrane Library 2012. 10.1002/14651858.CD010274
    1. Denison JA, O'Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS and Behavior. 2008; 12(3):363–373. 10.1007/s10461-007-9349-x
    1. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet. 2000; 356(9224):103–112.
    1. Thornton RL. The Demand for, and Impact of, Learning HIV Status. American Economic Review. 2008; 98(5):1829–63. 10.1257/aer.98.5.1829
    1. Matovu JKB, Gray RH, Makumbi F, Wawer MJ, Serwadda D, Kigozi G, et al. Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS. 2005; 19(5):503–511. 10.1097/01.aids.0000162339.43310.33
    1. Turner AN, Miller WC, Padian NS, Kaufman JS, Behets FM, Chipato T, et al. Unprotected sex following HIV testing among women in Uganda and Zimbabwe: short- and long-term comparisons with pre-test behaviour. International Journal of Epidemiology. 2009; 38(4):997–1007. 10.1093/ije/dyp171
    1. Sherr L, Lopman B, Kakowa M, Dube S, Chawira G, Nyamukapa C, et al. Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort. AIDS. 2007; 21(7):851–860. 10.1097/QAD.0b013e32805e8711
    1. Corbett EL, Makamure B, Cheung YB, Dauya E, Matambo R, Bandason T, et al. HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe. AIDS. 2007; 21(4):483–9. 10.1097/QAD.0b013e3280115402
    1. Coates TJ, Kulich M, Celentano DD, Zelaya CE, Chariyalertsak S, Chingono A, et al. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Global Health. 2014;2(5): E267–77. 10.1016/S2214-109X(14)70032-4
    1. World Health Organization. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV: recommendations for a public health approach and considerations for policy-makers and managers. 2013.
    1. Govindasamy D, Ferrand RA, Wilmore SM, Ford N, Ahmed S, Afnan‐Holmes H, et al. Uptake and yield of HIV testing and counselling among children and adolescents in sub‐Saharan Africa: a systematic review. Journal of the International AIDS Society. 2015;18(1):20182.
    1. Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013; 13, 220 10.1186/1471-2458-13-220
    1. Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014; 66: p. S144–S153 10.1097/QAI.0000000000000176
    1. Oginni A, Obianwu O, Adebajo S. Socio-demographic Factors Associated with Uptake of HIV Counseling and Testing (HCT) among Nigerian Youth. AIDS Research And Human Retroviruses. 2014; 30 (S1) A113–A113 10.1089/aid.2014.5216.abstract
    1. Nall A, Chenneville T, Rodriguez LM, O’Brien JL. Factors Affecting HIV Testing among Youth in Kenya. International journal of environmental research and public health. 2019;16(8):1450.
    1. Asaolu IO, Gunn JK, Center KE, Koss MP, Iwelunmor JI, Ehiri JE. Predictors of HIV testing among youth in sub-Saharan Africa: a cross-sectional study. PloS one. 2016;11(10):e0164052 10.1371/journal.pone.0164052
    1. Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N. Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2012;9(12):e1001351 10.1371/journal.pmed.1001351
    1. Grabbe KL, Menzies N, Taegtmeyer M, Emukule G, Angala P, Mwega I, et al. Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness. J Acquir Immune Defic Syndr. 2010;54(3): 317–23. 10.1097/QAI.0b013e3181ced126
    1. Cremin I, Nyamukapa C, Sherr L, Hallett TB, Chawira G, Cauchemez S, et al. Patterns of self-reported behaviour change associated with receiving voluntary counselling and testing in a longitudinal study from Manicaland, Zimbabwe. AIDS and Behavior. 2010; 14(3):708–15. 10.1007/s10461-009-9592-4
    1. Pant Pai N, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, et al. Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Med. 2013;10(4):e1001414 10.1371/journal.pmed.1001414
    1. Salazar-Austin N, Kulich M, Chingono A, Chariyalertsak S, Srithanaviboonchai K, Gray G, et al. Age-Related Differences in Socio-demographic and Behavioral Determinants of HIV Testing and Counseling in HPTN 043/NIMH Project Accept. AIDS and Behavior. 2018;22(2):569–79. 10.1007/s10461-017-1807-5
    1. Chandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reproductive health. 2014;11(1):1 10.1186/1742-4755-11-1
    1. Foss AM, Hossain M, Vickerman PT, Watts CH. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sexually Transmitted Infections. 2007; 83:510–16. 10.1136/sti.2007.027144
    1. O’Reilly KR, Fonner VA, Kennedy CE, Sweat MD. Free condom distribution: what we don’t know may hurt us. AIDS and Behavior. 2014; 18(11):2169–2171. 10.1007/s10461-014-0742-y
    1. Cohen J, Dupas P. Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment. Quarterly Journal of Economics. 2010; 125(1):1–45.
    1. Dupas P. Short-Run Subsidies and Long-Run Adoption of New Health Products: Evidence from a field experiment. Econometrica. 2014; 82(1):197–228. 10.3982/ECTA9508
    1. Dupas P, Hoffmann V, Kremer M, Zwane A. Targeting health subsidies through a non-price mechanism: A randomized controlled trial in Kenya. Science. 2016; 353(6302):889–895. 10.1126/science.aaf6288
    1. Papo JK, Bauni EK, Sanders EJ, Brocklehurst P, Jaffe HW. Exploring the condom gap: is supply or demand the limiting factor–condom access and use in an urban and a rural setting in Kilifi district, Kenya. AIDS. 2016;25(2):247–55.
    1. National AIDS and STI Control Programme, Kenya (NASCOP). 2007 Kenya AIDS Indicator Survey Final Report. 2009.
    1. Mugo N, Dadabhai SS, Bunnell R, Williamson J, Bennett E, Baya I, et al. Prevalence of herpes simplex virus type 2 infection, human immunodeficiency virus/herpes simplex virus type 2 coinfection, and associated risk factors in a national, population-based survey in Kenya. Sexually transmitted diseases. 2011;38(11):1059–66. 10.1097/OLQ.0b013e31822e60b6
    1. NASCOP. Kenya AIDS Indicator Survey 2012: Final Report. 2014.
    1. Duflo E, Dupas P, Kremer M. Education, HIV, and Early Fertility: Experimental Evidence from Kenya. American Economic Review. 2015; 105(9):2257–97.
    1. Kenya National Bureau of Statistics and ICF Macro. Kenya Demographic and Health Survey 2008–09. 2010. Calverton, Maryland: Kenya National Bureau of Statistics and ICF Macro.
    1. NASCOP. Guidelines for HIV Testing and Counselling in Kenya. 2008.
    1. Behling J, Chan AK, Zeh C, Nekesa C, Heinzerling L. Evaluating HIV prevention programs: herpes simplex virus type 2 antibodies as biomarker for sexual risk behavior in young adults in resource-poor countries. PloS one. 2015;10(5):e0128370 10.1371/journal.pone.0128370
    1. Kenya National Bureau of Statistics; Ministry of Health/Kenya; National AIDS Control Council/Kenya; Kenya Medical Research Institute; National Council for Population and Development/Kenya; ICF International. Kenya Demographic and Health Survey 2014. 2015. Available online:
    1. Gong E. HIV Testing and risky sexual behavior. The Economic Journal. 2015; 125 (582):32–60.
    1. PATH. APHIA II Western Province. Best Practices and Promising Interventions. March 2011.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다