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Open Access

Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study

Avina Sarna, Stanley Luchters, Eustasius Musenge, Jerry Okal, Matthew Chersich, Waimar Tun, Sabine Mall, Nzioki Kingola and Sam Kalibala
Global Health: Science and Practice March 2013, 1(1):52-67; https://doi.org/10.9745/GHSP-D-12-00023
Avina Sarna
aHIV and AIDS Program, Population Council, Delhi, India
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  • For correspondence: asarna@popcouncil.org
Stanley Luchters
bInternational Centre for Reproductive Health, University of Ghent, Belgium
cFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
dBurnet Institute, Melbourne, Victoria, Australia
eMonash University, Victoria, Australia
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Eustasius Musenge
cFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Jerry Okal
fHIV and AIDS Program, Population Council, Nairobi, Kenya
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Matthew Chersich
bInternational Centre for Reproductive Health, University of Ghent, Belgium
cFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Waimar Tun
gHIV and AIDS Program, Population Council, Washington, DC, USA
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Sabine Mall
hInternational Centre for Reproductive Health, Mombasa, Kenya
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Nzioki Kingola
hInternational Centre for Reproductive Health, Mombasa, Kenya
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Sam Kalibala
gHIV and AIDS Program, Population Council, Washington, DC, USA
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Figures & Tables

Figures

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  • FIGURE 1.
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    FIGURE 1.

    Flow Diagram of Progress of HIV-Infected Study Participants Through the Study

Tables

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    Table 1. Baseline Characteristics of HIV-Infected Adults Enrolled in Intervention and Control Sites in Mombasa, Kenya, and of a Propensity Score-Matched Selected Population
    VariableEnrolled Population (N = 634)Propensity Score-Matched Population (N = 394)a
    Intervention (n = 325)Control (n = 309)P ValuebIntervention (n = 204)Control (n = 190)P Valueb
    Socio-Demographic Characteristics
    Female, n (%)250 (76.9)221 (71.5)0.12157 (77.0)150 (79.0)0.64
    Age, mean years (SD)35.2 (8.4)35.6 (8.2)0.51c35.1 (8.6)34.6 (7.9)0.54c
    Education, n (%)
    No schooling30 (9.2)30 (9.7)18 (8.8)21 (11.1)
    Primary education206 (63.4)190 (61.5)130 (63.7)109 (57.4)
    Secondary or higher education89 (27.4)89 (28.8)0.8756 (27.4)60 (31.6)0.42
    Marital status, n (%)
    Married or cohabiting98 (30.2)165 (53.4)67 (32.8)96 (50.5)
    Single78 (24.0)47 (15.2)48 (23.5)29 (15.4)
    Separated or divorced80 (24.6)51 (16.5)45 (22.1)35 (18.4)
    Widowed69 (21.2)46 (14.9)<0.001*44 (21.6)30 (15.8)0.004*
    Living arrangements, n (%)
    Stays alone163 (50.2)67 (21.7)94 (46.1)47 (24.7)
    Nuclear family103 (31.7)193 (62.5)70 (34.3)116 (61.1)
    Extended family/friends59 (18.2)49 (15.9)<0.001*40 (19.6)27 (14.2)<0.001*
    Religion, n (%)
    Catholic120 (36.9)35 (11.3)49 (24.0)31 (16.3)
    Protestant135 (41.5)109 (35.3)93 (45.9)101 (53.2)
    Muslim66 (20.3)164 (53.1)62 (30.4)57 (30.0)
    No religion4 (1.2)1 (0.3)<0.001*…1 (0.5)0.17
    Employment, n (%)
    Salaried job or self-employed56 (17.2)33 (10.7)29 (14.2)27 (14.2)
    Daily wage worker88 (27.1)71 (23.0)61 (29.9)50 (26.3)
    Vendor or hawker55 (17.0)76 (24.5)50 (24.5)51 (26.8)
    Green grocer15 (4.6)10 (3.2)7 (3.4)7 (3.7)
    Unemployed49 (15.1)49 (15.9)36 (17.7)34 (17.9)
    Other34 (10.5)36 (11.7)<0.001*21 (10.3)21 (11.1)0.98
    HIV-Related Characteristics
    Number HIV tests done, n (%)e
    1165 (50.8)207 (67.2)104 (51.0)126 (66.3)
    2-4139 (42.8)92 (29.9)87 (42.7)58 (30.5)
    5 or more21 (6.5)9 (2.9)<0.001*13 (6.4)6 (3.2)0.007*
    Months since HIV-positive diagnosis, n (%)e
    0-1183 (25.9)102 (34.6)51 (25.4)61 (34.1)
    12-2374 (23.1)69 (23.4)46 (22.9)42 (23.5)
    24 or more163 (50.9)124 (42.0)0.040*104 (51.7)76 (42.5)0.12
    Ever taken antiretroviral drugs (including for PMTCT), n (%)125 (38.5)119 (38.5)0.5975 (36.8)66 (34.7)0.68
    Currently attends HIV clinic4 (1.2)14 (4.5)0.012*3 (1.5)9 (4.7)0.06
    Disclosed HIV status to main partner, n (%)e
    Yes160 (51.3)203 (70.7)102 (52.0)121 (68.8)
    No, but plans to disclose67 (21.5)41 (14.3)39 (19.9)29 (16.5)
    No, does not intend to disclose46 (14.7)27 (9.4)30 (15.3)17 (9.7)
    No, cannot say/maybe will disclose39 (12.5)16 (5.6)<0.001*25 (12.8)9 (5.1)0.004*
    Disclosed HIV status to anyone besides health workers, n (%)245 (75.4)272 (88.0)<0.001*157 (77.0)164 (86.3)0.02*
    Sexual Behavior Characteristics
    Age at first sex, median n (IQR, range)18 (15–19, 7–42)18 (15–19, 7–35)0.91d18 (9–25, 7–42)17 (11–26, 7–35)0.30d
    Number lifetime partners, median n (IQR, range)5 (3–9, 1–53)4 (3–9, 1–57)0.49d5 (1–20, 1–30)4 (1–35, 1–57)0.28d
    Ever had same sex partners, n (%)17 (5.2)15 (4.9)0.868 (3.9)10 (5.3)0.52
    Has regular sexual partner(s), n (%)312 (96.0)287 (92.7)0.09379 (42.9)44 (24.9)<0.001*
    Has children, n (%)281 (86.5)265 (85.8)0.80176 (86.3)162 (85.3)0.77
    Currently using family planning, n (%)187 (57.5)163 (52.8)0.46112 (58.0)96 (53.9)0.33
    • Abbreviations: SD, standard deviation; PMTCT, prevention of mother-to-child transmission; IQR, interquartile range.

    • ↵* P values < 0.05 were considered statistically significant.

    • ↵a The following variables were used in propensity score matching: age, gender, education, religion, and employment.

    • ↵b Pearson's chi-square test unless otherwise indicated.

    • ↵c t-test.

    • ↵d Mann-Whitney test.

    • ↵e For the enrolled population, sample size of control group for number of HIV tests done is 308; of intervention and control group for months since HIV-positive diagnosis is 320 and 295, respectively; of intervention and control group for disclosed HIV status to main partner is 312 and 287, respectively.

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    Table 2. Sexual and Behavioral Outcomes Among HIV-Infected Men and Women Before and 6 Months After a Behavioral Intervention in Mombasa, Kenya (N = 605)
    VariableIntervention (n = 315)Control (n = 290)
    Before n/N (%)After n/N (%)P ValueaBefore n/N (%)After n/N (%)P Valuea
    Number of partners in past 3 months
    0 partners11/297 (3.7)58/313 (18.5)9/283 (3.2)54/286 (18.9)
    1 partner158/297 (53.2)202/313 (64.5)201/283 (71.0)174/286 (60.8)
    ≥2 partners128/297 (43.1)53/313 (16.9)<0.001*b73/283 (25.8)58/286 (20.3)0.06b
    Unprotected sex at last sexc,d
    Spouse68/93 (73.1)9/79 (11.4)<0.001*97/144 (67.4)85/141 (60.3)0.19
    Regular partner71/115 (61.7)4/92 (4.4)<0.001*56/125 (44.8)54/105 (51.4)1.00
    Casual partner89/142 (62.7)11/101 (10.9)<0.001*15/31 (48.4)20/33 (60.6)1.00
    Commercial partner36/53 (67.9)2/33 (6.1)0.025*25/43 (58.1)13/28 (46.4)0.025*
    Unprotected sex in past monthd,e
    0 acts115/307 (37.5)225/258 (87.2)115/282 (40.8)126/238 (52.9)
    1-5 acts87/307 (28.4)28/258 (10.9)102/282 (36.1)69/238 (29.0)
    ≥6 or more acts105/307 (34.2)5/258 (1.9)<0.001*b65/282 (23.1)43/238 (18.1)0.002*b
    Unsafe sex in past monthd,e
    0 HIV-negative or unknown status partner137/307 (44.6)240/258 (93.0)172/282 (61.0)168/238 (70.6)
    1 HIV-negative or unknown status partner23/307 (7.5)4/258 (1.6)26/282 (9.2)10/238 (4.2)
    2-5 HIV-negative or unknown status partners59/307 (19.2)10/258 (3.9)43/282 (15.3)33/238 (13.9)
    ≥6 HIV-negative or unknown status partners88/307 (28.7)4/258 (1.6)<0.001*b41/282 (14.5)27/238 (11.3)0.003*b
    Condom use self-efficacy
    Low self-efficacy (score 15-34)23/315 (7.3)2/315 (0.6)8/290 (2.8)0/290 (0)
    Moderate self-efficacy (score 35-54)169/315 (53.7)31/315 (9.8)129/290 (44.5)147/290 (50.7)
    High self-efficacy (score 55-75)123/315 (39.1)282/315 (89.5)<0.001*153/290 (52.8)143/290 (49.3)0.86
    HIV status disclosed to partnerc,d
    Spouse65/93 (70.0)74/79 (93.7)<0.001*120/144 (83.3)125/141 (88.7)0.083
    Regular partner(s)16/115 (13.9)8/92 (8.7)0.6511/125 (8.8)16/105 (15.2)0.41
    Casual partner(s)19/142 (13.4)10/101 (9.9)1.007/31 (22.6)12/33 (36.4)1.00
    Commercial partner(s)8/53 (15.1)7/33 (21.2)0.166/43 (14.0)7/28 (25.0)0.56
    Currently receiving antiretroviral treatment1/315 (0.3)111/315 (35.2)<0.001*1/290 (0.3)36/290 (12.4)<0.001*
    Internalized stigma
    Low (score 16-40)78/314 (24.8)133/314 (42.4)152/290 (52.4)172/290 (59.3)
    Moderate (score 41-52)232/314 (73.9)181/314 (57.6)134/290 (46.2)113/290 (39.0)
    High (score 53-64)4/314 (1.3)0/31 (0)<0.001*4/290 (1.4)5/290 (1.7)0.09
    • ↵* P values < 0.05 were considered statistically significant.

    • ↵a McNemar test unless otherwise indicated.

    • ↵b Marginal homogeneity (Stuart-Maxwell) test.

    • ↵c Multiple-response question.

    • ↵d Respondents were asked to report on all sexual partners in the past 3 months with a maximum of 6 partners.

    • e Only among sexually active participants.

    • View popup
    Table 3. Propensity Score-Matcheda Sexual and Behavioral Outcomes Among HIV-Infected Men and Women After a 6-Month Behavioral Intervention (N = 394)
    VariableEnd of study
    Intervention n/N (%)Control n/N (%)P Valueb
    Number of partners in past 3 months
    0 partners36/204 (17.7)34/190 (17.9)
    1 partner135/204 (66.2)119/190 (62.6)
    ≥2 partners33/204 (16.2)37/190 (19.5)0.61c
    Unprotected sex at last sexd,e
    Spouse5/55 (9.1)55/98 (56.1)<0.001*
    Regular partner3/59 (5.1)33/68 (48.5)<0.001*
    Casual partner10/65 (15.4)15/25 (60.0)<0.001*
    Commercial partner2/23 (8.7)9/19 (47.4)0.005*
    Unprotected sex in past monthe,f
    0 acts150/171 (87.7)87/161 (54.0)
    1 acts5/171 (2.9)11/161 (6.8)
    2-5 acts11/171 (6.4)36/161 (22.4)
    6 or more acts5/171 (2.9)27/161 (16.8)<0.001*c
    Unsafe sex in past monthe,f
    0 HIV-negative or unknown-status partner158/171 (92.4)114/161 (70.8)
    1 HIV-negative or unknown-status partner3/171 (1.8)6/161 (3.7)
    2-5 HIV-negative or unknown-status partners5/171 (3.5)22/161 (13.7)
    ≥6 HIV-negative or unknown-status partners4/171 (2.3)19/161 (11.8)<0.001*c
    Condom use self-efficacy
    Low self-efficacy (score 15-34)2/204 (1.0)0/190 (0)
    Moderate self-efficacy (score 35-54)21/204 (10.3)90/190 (47.4)
    High self-efficacy (score 55-75)181/204 (88.7)100/190 (52.6)<0.001*c
    HIV status disclosed to partnerd,e
    Spouse52/55 (94.5)89/98 (90.8)0.41
    Regular partner(s)5/59 (8.5)10/68 (14.7)0.28
    Casual partner(s)6/65 (9.2)9/25 (36.0)0.002*
    Commercial partner(s)5/23 (21.7)6/19 (31.6)0.47
    Currently receiving antiretroviral treatment70/204 (34.3)24/189 (12.7)<0.001*
    Internalized stigma
    Low (score 16-40)90/203 (44.3)107/190 (56.3)
    Moderate (score 41-52)113/203 (55.7)81/190 (42.6)
    High (score 53-64)0/203 (0.0)2/190 (1.1)0.034*c
    • ↵* P values < 0.05 were considered statistically significant.

    • ↵a The following variables were used in propensity score matching: age, gender, education, religion, and employment.

    • ↵b Pearson’s chi-square test unless otherwise indicated.

    • ↵c Chi-square test for trend.

    • ↵d Multiple-response question.

    • ↵e Respondents were asked to report on all their sexual partners in the past 3 months with a maximum of 6 partners.

    • f Only among sexually active participants.

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Global Health: Science and Practice: 1 (1)
Global Health: Science and Practice
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March 01, 2013
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Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study
Avina Sarna, Stanley Luchters, Eustasius Musenge, Jerry Okal, Matthew Chersich, Waimar Tun, Sabine Mall, Nzioki Kingola, Sam Kalibala
Global Health: Science and Practice Mar 2013, 1 (1) 52-67; DOI: 10.9745/GHSP-D-12-00023

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Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study
Avina Sarna, Stanley Luchters, Eustasius Musenge, Jerry Okal, Matthew Chersich, Waimar Tun, Sabine Mall, Nzioki Kingola, Sam Kalibala
Global Health: Science and Practice Mar 2013, 1 (1) 52-67; DOI: 10.9745/GHSP-D-12-00023
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