Long-Term Biological and Behavioural Impact of an Adolescent Sexual Health Intervention in Tanzania: Follow-up Survey of the Community-Based MEMA kwa Vijana Trial
Background:
The ability of specific behaviour-change interventions to reduce HIV infection in young people remains questionable. Since January 1999, an adolescent sexual and reproductive health (SRH) intervention has been implemented in ten randomly chosen intervention communities in rural Tanzania, within a community randomised trial (see below; NCT00248469). The intervention consisted of teacher-led, peer-assisted in-school education, youth-friendly health services, community activities, and youth condom promotion and distribution. Process evaluation in 1999–2002 showed high intervention quality and coverage. A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 (HSV-2) seroprevalence but found substantial improvements in SRH knowledge, reported attitudes, and some reported sexual behaviours. It was postulated that the impact on “upstream” knowledge, attitude, and reported behaviour outcomes seen at the 3-year follow-up would, in the longer term, lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes. A further impact evaluation survey in 2007/8 (∼9 years post-intervention) tested this hypothesis.
Methods and Findings:
This is a cross-sectional survey (June 2007 through July 2008) of 13,814 young people aged 15–30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial (1999–2002). Prevalences of the primary outcomes HIV and HSV-2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio [aPR] 0.91, 95%CI 0.50–1.65; females aPR 1.07, 95%CI 0.68–1.67) or HSV-2 (males aPR 0.94, 95%CI 0.77–1.15; females aPR 0.96, 95%CI 0.87–1.06). The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime (aPR 0.87, 95%CI 0.78–0.97) and an increase in reported condom use at last sex with a non-regular partner among females (aPR 1.34, 95%CI 1.07–1.69). There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies, or other reported sexual behaviours. The study population was likely to have been, on average, at lower risk of HIV and other sexually transmitted infections compared to other rural populations, as only youth who had reached year five of primary school were eligible.
Conclusions:
SRH knowledge can be improved and retained long-term, but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated.
Trial Registration: ClinicalTrials.gov NCT00248469
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Long-Term Biological and Behavioural Impact of an Adolescent Sexual Health Intervention in Tanzania: Follow-up Survey of the Community-Based MEMA kwa Vijana Trial. PLoS Med 7(6): e32767. doi:10.1371/journal.pmed.1000287
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000287
Souhrn
Background:
The ability of specific behaviour-change interventions to reduce HIV infection in young people remains questionable. Since January 1999, an adolescent sexual and reproductive health (SRH) intervention has been implemented in ten randomly chosen intervention communities in rural Tanzania, within a community randomised trial (see below; NCT00248469). The intervention consisted of teacher-led, peer-assisted in-school education, youth-friendly health services, community activities, and youth condom promotion and distribution. Process evaluation in 1999–2002 showed high intervention quality and coverage. A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 (HSV-2) seroprevalence but found substantial improvements in SRH knowledge, reported attitudes, and some reported sexual behaviours. It was postulated that the impact on “upstream” knowledge, attitude, and reported behaviour outcomes seen at the 3-year follow-up would, in the longer term, lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes. A further impact evaluation survey in 2007/8 (∼9 years post-intervention) tested this hypothesis.
Methods and Findings:
This is a cross-sectional survey (June 2007 through July 2008) of 13,814 young people aged 15–30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial (1999–2002). Prevalences of the primary outcomes HIV and HSV-2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio [aPR] 0.91, 95%CI 0.50–1.65; females aPR 1.07, 95%CI 0.68–1.67) or HSV-2 (males aPR 0.94, 95%CI 0.77–1.15; females aPR 0.96, 95%CI 0.87–1.06). The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime (aPR 0.87, 95%CI 0.78–0.97) and an increase in reported condom use at last sex with a non-regular partner among females (aPR 1.34, 95%CI 1.07–1.69). There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies, or other reported sexual behaviours. The study population was likely to have been, on average, at lower risk of HIV and other sexually transmitted infections compared to other rural populations, as only youth who had reached year five of primary school were eligible.
Conclusions:
SRH knowledge can be improved and retained long-term, but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated.
Trial Registration: ClinicalTrials.gov NCT00248469
: Please see later in the article for the Editors' Summary
Zdroje
1. UNAIDS 2008 Report on the global HIV/AIDS epidemic 2008. Geneva UNAIDS (UNAIDS/08.25E/JC1510E UNAIDS/08.25E/JC1510E) 362
2. TemmermanM
1994 Sexually transmitted diseases and reproductive health. Sex Transm Dis 21 S55 58
3. ObasiAI
BaliraR
ToddJ
RossDA
ChangaluchaJ
2001 Prevalence of HIV and Chlamydia trachomatis infection in 15-19-year olds in rural Tanzania. Trop Med Int Health 6 517 525
4. PequegnatW
StoverE
2000 Behavioral prevention is today's AIDS vaccine! AIDS 14 Suppl 2 S1 7
5. UNICEF 2002 Young people and HIV/AIDS: Opportunity in crisis. New York UNICEF
6. UNAIDS 2007 Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access. Geneva UNAIDS (UNAIDS/07.07E/JC1274E UNAIDS/07.07E/JC1274E) 68
7. WHOUNAIDS 2007 New data on male circumcision and HIV prevention: policy and programme implications: WHO/UNAIDS Technical Consultation, Male Circumcision and HIV Prevention: Research Implications for Policy and Programming, Montreux, 6–7 March 2007:conclusions and recommendations. Geneva World Health Organization 10
8. WeissHA
HalperinD
BaileyRC
HayesRJ
SchmidG
2008 Male circumcision for HIV prevention: from evidence to action? AIDS 22 567 574
9. HendersonM
WightD
RaabGM
AbrahamC
ParkesA
2007 Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial. BMJ 334 133
10. DiCensoA
GuyattG
WillanA
GriffithL
2002 Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. BMJ 324 1426 1430
11. GallantM
Maticka-TyndaleE
2004 School-based HIV prevention programmes for African youth. Soc Sci Med 58 1337 1351
12. PronykPM
HargreavesJR
KimJC
MorisonLA
PhetlaG
2006 Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 368 1973 1983
13. JewkesR
NdunaM
LevinJ
JamaN
DunkleK
2008 Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ 337 a506
14. StephensonJ
StrangeV
AllenE
CopasA
JohnsonA
2008 The long-term effects of a peer-led sex education programme (RIPPLE): a cluster randomised trial in schools in England. PLoS Med 5 e224 doi:10.1371/journal.pmed.0050224
15. KirbyD
ObasiA
LarisBA
2006 The effectiveness of sex education and HIV education interventions in schools in developing countries.
RossDA
DickB
FergusonJ
938 103 150 Preventing HIV/AIDS in Young People: a systematic review of the evidence from developing countries. WHO Tech Rep Ser
16. CowanFM
PascoeSJ
LanghaugLF
DirawoJ
ChidiyaS
2008 The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe–study design and baseline results. Trop Med Int Health 13 1235 1244
17. CataniaJA
GibsonDR
ChitwoodDD
CoatesTJ
1990 Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull 108 339 362
18. McFarlaneM
St LawrenceJS
1999 Adolescents' recall of sexual behavior: consistency of self-report and effect of variations in recall duration. J Adolesc Health 25 199 206
19. WightD
WestP
1999 Poor recall, misunderstandings and embarrassment: interpreting discrepancies in young men's reported heterosexual behaviour. Cult Health Sex 1 55 78
20. PlummerML
RossDA
WightD
ChangaluchaJ
MshanaG
2004 “A bit more truthful”: the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sex Transm Infect 80 Suppl2 ii49 ii56
21. HayesRJ
ChangaluchaJ
RossDA
GavyoleA
ToddJ
2005 The MEMA kwa Vijana project: design of a community randomised trial of an innovative adolescent sexual health intervention in rural Tanzania. Contemp Clin Trials 26 430 442
22. ObasiAI
CleophasB
RossDA
ChimaKL
MmassyG
2006 Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania. AIDS Care 18 311 322
23. RossDA
ChangaluchaJ
ObasiAI
ToddJ
PlummerML
2007 Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS 21 1943 1955
24. PlummerML
WightD
ObasiAIN
WamoyiJ
MshanaG
2007 A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme. Health Educ Res 22 500 512
25. GuyonA
LugoeWL
FergusonJ
2000 Evaluation report of HIV/AIDS peer education in the MEMA kwa Vijana project, Mwanza, Tanzania. AMREF, NIMR and LSHTM Collaborative Research Projects (Unpublished report)
26. KirbyD
2001 The Mema kwa Vijana Curriculum: A Review. Santa Cruz, California ETR Associates 8 (Unpublished report)
27. LugoeWL
2001 Evaluation of Teacher-training sessions for MkV teacher led component. Dar es Salaam Faculty of Education, University of Dar es Salaam (Unpublished report)
28. RenjuJ
NyalaliK
2008 Scaling up ASRH education through widespread teacher training: training evaluation report. National Institute for Medical Research, Mwanza, Tanzania and Liverpool School of Tropical Medicine, UK 24 (www.memakwavijana.org)
29. RenjuJ
NyalaliK
2008 Scaling up Youth Friendly health services through widespread health worker training; training evaluation report. National Institute for Medical Research, Mwanza, Tanzania and Liverpool School of Tropical Medicine, UK 40 (www.memakwavijana.org)
30. BoermaJT
UrassaM
NnkoS
Ng'weshemiJ
IsingoR
2002 Sociodemographic context of the AIDS epidemic in a rural area in Tanzania with a focus on people's mobility and marriage. Sex Transm Infect 78 Suppl 1 i97 105
31. RossauR
HeyndrickxL
Van HeuverswynH
1988 Nucleotide sequence of a 16S ribosomal RNA gene from Neisseria gonorrhoeae. Nucleic Acids Res 16 6227
32. RoymansR
OnlandG
JanszA
QuintW
BoelE
1999 Evaluation of an in-house polymerase chain reaction for detection of Neisseria gonorrhoeae in urogenital samples. J Clin Pathol 52 411 414
33. GrosskurthH
MoshaF
ToddJ
MwijarubiE
KlokkeA
1995 Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 346 530 536
34. del Mar Pujades RodriguezM
ObasiA
MoshaF
ToddJ
BrownD
2002 Herpes simplex virus type 2 infection increases HIV incidence: a prospective study in rural Tanzania. AIDS 16 451 462
35. HayesRJ
MoultonLH
2009 Cluster Randomised Trials. CRC Press, Boca Raton, USA
36. MakokhaM
2008 What MEMA kwa Vijana has to offer the education sector AIDS response in Tanzania: A comparative review. National Institute for Medical Research, Medical Research Council, UK and Liverpool School of Tropical Medicine, UK 69 (www.memakwavijana.org)
37. MwitaW
WhiteR
ChilonganiJ
OrrothK
ZabaB
2002 The association between population mobility and HIV prevalence in rural villages in Mwanza region, Tanzania. Trans R Soc Trop Med Hyg 96 363 364
38. United Nations 2001 UNGASS Goals. Declaration of commitment on HIV/AIDS. New York, United Nations, 2001
39. WightD
PlummerML
MshanaG
WamoyiJ
ShigongoZS
2006 Contradictory sexual norms and expectations for young people in rural Northern Tanzania. Soc Sci Med 62 987 997
40. PlummerML
WightD
WamoyiJ
MshanaG
HayesRJ
2006 Farming with your hoe in a sack: condom attitudes, access, and use in rural Tanzania. Stud Fam Plann 37 29 40
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