Kamuzu University of Health Sciences , Private Bag 360, Blantyre, Malawi.
School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street (M/C 932), Chicago, IL, 60612, USA.
BMC Public Health. 2023 Feb 10;23(1):301. doi: 10.1186/s12889-022-14715-3.
HIV prevention knowledge levels are low in sub-Saharan Africa. In our efficacy study, the Mzake ndi Mzake (Friend-to-Friend; hereafter Mzake) 6-session peer group intervention, delivered by health workers, improved HIV prevention knowledge and other outcomes in Malawi. To expand HIV prevention approaches, this implementation study tested whether the intervention remained effective when implemented by trained community volunteers. HIV prevention knowledge findings are presented.
Using a stepped wedge design, three communities implemented the Mzake program sequentially in randomly assigned order. Repeated surveys assessed outcomes, and participants served as controls until they completed the program. At Time 2, Community 1 became the intervention group, and at Time 3, Communities 1 and 2 were the intervention group. HIV prevention knowledge, the primary outcome, was assessed through two indicators: UNAIDS comprehensive knowledge (UNAIDS Knowledge), defined as correctly answering five HIV prevention questions (Yes/No), and a 9-item HIV/PMTCT Knowledge Index (number correct). Multivariate generalized estimating equation logistic regression (UNAIDS Knowledge) and mixed-effects regression models (HIV/PMTCT Knowledge Index) were used to assess knowledge controlling for five sociodemographic factors.
In bivariate analyses of UNAIDS Knowledge, more persons answered correctly in the intervention group than the control group at Time 2 (56.8% vs. 47.9%, p < 0.01), but the difference was not significant at Time 3. In logistic regression, there was a significant linear increase in the proportion who correctly answered all questions in the control group, but the increase was significantly higher in the intervention group (log-odds estimate = 0.17, SE = 0.06, p-value < 0.01). The HIV/PMTCT Knowledge Index scores increased over time for both groups, but in the intervention group the increase was significantly higher than the control group (0.11 at Time 2; 0.21 at Time 3). In youth and adult subsamples analyses, the intervention was highly effective in increasing knowledge for youth, but not for adults.
This implementation study showed that Mzake was effective in increasing HIV prevention knowledge when delivered by community members. Community approaches offer an important strategy to increase HIV prevention in rural communities without burdening healthcare systems.
ClinicalTrials.gov NCT02765659. Registered 06/05/2016.
在撒哈拉以南非洲，艾滋病毒预防知识水平较低。在我们的疗效研究中，Mzake ndi Mzake（朋友到朋友；以下简称 Mzake）由卫生工作者提供的 6 节同伴小组干预措施提高了艾滋病毒预防知识和其他结果在马拉维。为了扩大艾滋病毒预防方法，这项实施研究测试了当由经过培训的社区志愿者实施时，该干预措施是否仍然有效。现将艾滋病毒预防知识的研究结果报告如下。
采用阶梯式楔形设计，三个社区依次按随机顺序实施 Mzake 方案。重复调查评估结果，参与者在完成方案前担任对照。在时间 2 时，社区 1 成为干预组，在时间 3 时，社区 1 和 2 成为干预组。通过两个指标评估艾滋病毒预防知识，主要结果：UNAIDS 综合知识（UNAIDS 知识），定义为正确回答五个艾滋病毒预防问题（是/否）和九个艾滋病毒/PMTCT 知识指数（正确数）。采用多变量广义估计方程逻辑回归（UNAIDS 知识）和混合效应回归模型（HIV/PMTCT 知识指数），控制五个社会人口统计学因素评估知识。
UNAIDS 知识的二元分析显示，干预组正确回答的人数多于对照组，在时间 2 时（56.8%比 47.9%，p <0.01），但在时间 3 时差异无统计学意义。在逻辑回归中，对照组正确回答所有问题的比例呈显著线性增加，但干预组的增加幅度明显更高（对数优势估计值=0.17，SE=0.06，p 值<0.01）。HIV/PMTCT 知识指数评分随时间推移在两组均有所增加，但干预组的增加幅度明显高于对照组（时间 2 时为 0.11；时间 3 时为 0.21）。在青年和成人亚样本分析中，该干预措施在提高青年的知识方面非常有效，但对成年人则无效。
这项实施研究表明，当由社区成员提供时，Mzake 能够有效提高艾滋病毒预防知识。社区方法为增加农村社区的艾滋病毒预防提供了一个重要策略，而不会给医疗保健系统带来负担。
ClinicalTrials.gov NCT02765659。注册于 2016 年 6 月 5 日。
