Massachusetts Institute of Technology, Cambridge, MA, United States of America.
Stanford University, Stanford, CA, United States of America.
PLoS One. 2019 Jul 30;14(7):e0219535. doi: 10.1371/journal.pone.0219535. eCollection 2019.
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.
目的:艾滋病毒自愿咨询检测(VCT)和增加男用避孕套的可及性是应对艾滋病毒/艾滋病大流行的常见策略。本研究采用生物学和行为学结果,比较了在肯尼亚西部,通过社区为基础的 VCT 增加、男用避孕套增加或两者同时增加的方案,与该环境中标准的现有艾滋病毒预防服务相比,对青年人群的影响。
设计:四臂、非盲随机对照试验。
方法:该样本包括 10245 名年龄在 17 至 24 岁的青年,他们被随机分配接受社区为基础的 VCT、150 个男用避孕套、VCT 和避孕套或两者都没有。所有参与者都可以获得社区内提供的标准艾滋病毒服务。在基线(2009-2010 年)和随访(2011-2013 年)时收集疱疹病毒 2 型(HSV-2)检测的调查和血样。在随访时向所有参与者提供 VCT。HSV-2 患病率是主要结局,在意向治疗分析中使用加权逻辑回归进行评估。
结果:在随访时接受调查的 7565 名应答者中(有效跟踪率=91%),各组之间的加权 HSV-2 患病率相似(对照组为 10.8%,避孕套组为 9.1%,VCT 组为 10.2%,VCT 和避孕套组为 11.5%)。没有任何干预措施显著降低 HSV-2 患病率;调整后的比值比分别为避孕套组 0.87(95%可信区间:0.61-1.25),VCT 组 0.94(95%可信区间:0.64-1.38),两者均为 1.12(95%可信区间:0.79-1.58)。VCT 干预措施显著增加了艾滋病毒检测(仅 VCT 调整后的比值比为 3.54,95%可信区间为 2.32-5.41,VCT 和避孕套组为 5.52,95%可信区间为 3.90-7.81)。在艾滋病毒风险或其他行为和知识结果(包括自我报告的怀孕率)方面,没有统计学意义的影响。
结论:本研究表明,系统的社区为基础的 VCT 运动(除了当地卫生诊所提供 VCT 服务)和避孕套的分发,单独使用不太可能显著降低青年人群中 HSV-2 的流行率。
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