London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
BMC Infect Dis. 2023 Oct 31;22(Suppl 1):974. doi: 10.1186/s12879-023-08695-x.
There is a growing body of evidence for the role that communities can have in producing beneficial health outcomes. There is also an increasing recognition of the effectiveness and success of community-led interventions to promote public health efforts. This study investigated whether and how community-level measures facilitate a community-led intervention to achieve improved HIV outcomes.
This is a secondary analysis of survey data from a cluster randomised trial in 40 rural communities in Zimbabwe. The survey was conducted four months after the intervention was initiated. Communities were randomised 1:1 to either paid distribution arm, where HIV self-test (HIVST) kits were distributed by a paid distributor, or community-led whereby members of the community were responsible for organising and conducting the distribution of HIVST kits. We used mixed effects logistic regression to assess the effect of social cohesion, problem solving, and HIV awareness on HIV testing and prevention.
We found no association between community measures and the three HIV outcomes (self-testing, new HIV diagnosis and linkage to VMMC or confirmatory testing). However, the interaction analyses highlighted that in high social cohesion communities, the odds of new HIV diagnosis was greater in the community-led arm than paid distribution arm (OR 2.06 95% CI 1.03-4.19).
We found some evidence that community-led interventions reached more undiagnosed people living with HIV in places with high social cohesion. Additional research should seek to understand whether the effect of social cohesion is persistent across other community interventions and outcomes.
PACTR201607001701788.
越来越多的证据表明，社区在产生有益健康结果方面可以发挥作用。人们也越来越认识到以社区为基础的干预措施在促进公共卫生工作方面的有效性和成功。本研究调查了社区层面的措施是否以及如何促进社区主导的干预措施，以实现改善艾滋病毒结果。
这是对津巴布韦 40 个农村社区进行的一项集群随机试验的调查数据的二次分析。调查是在干预开始四个月后进行的。社区按照 1:1 的比例随机分为有偿分配组和社区主导组，前者由付费经销商分发艾滋病毒自检 (HIVST) 试剂盒，后者由社区成员负责组织和进行 HIVST 试剂盒的分发。我们使用混合效应逻辑回归来评估社会凝聚力、解决问题和艾滋病毒意识对艾滋病毒检测和预防的影响。
我们没有发现社区措施与三个艾滋病毒结果（自我检测、新的艾滋病毒诊断以及与 VMMC 或确认检测的联系）之间存在关联。然而，交互分析强调，在社会凝聚力高的社区中，社区主导组比有偿分配组新的艾滋病毒诊断几率更高（OR 2.06 95% CI 1.03-4.19）。
我们发现一些证据表明，在社会凝聚力高的地方，社区主导的干预措施能够接触到更多未被诊断出的艾滋病毒感染者。应开展更多研究，以了解社会凝聚力的影响是否在其他社区干预措施和结果中持续存在。
PACTR201607001701788。
