College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA.
Malawi Liverpool Wellcome Clinical Research Program, P.O Box 30096, Chichiri, Blantyre 3, Malawi.
BMC Public Health. 2024 Jun 3;24(1):1483. doi: 10.1186/s12889-024-18991-z.
BACKGROUND: HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. METHODS: Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. RESULTS: This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. CONCLUSIONS: In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa. TRIAL REGISTRATION: Clinical Trials.gov NCT02765659 Registered May 6, 2016.
背景：艾滋病毒预防仍然是全球的重点，尤其是在撒哈拉以南非洲地区。我们的研究团队此前开发了一种基于证据的同伴小组艾滋病毒预防方案，称为Mzake ndi Mzake（朋友到朋友）。一个社区参与的合作组织对该方案进行了调整，以实现社区拥有和实施。在这里，我们报告了该艾滋病毒预防方案是否通过社区志愿者的实施，增加了马拉维农村地区性活跃个体的 condom 使用。
方法：三个社区依次推出该方案。使用阶梯式楔形设计评估有效性。在 2016 年至 2019 年期间，每 11-13 个月重复进行一次调查。在时间 1 时，没有社区提供干预措施。在时间 2 时，第一个社区提供了干预措施，而另外两个社区没有（对照组）。在时间 3 时，两个社区提供了干预措施，而一个社区没有（对照组）。我们使用了两个 condom 使用指标；最近两个月的 condom 使用频率（n=771）和最近一次性行为时使用 condom（n=880）。分析样本包括在一个或多个时间点回答该问题的所有性活跃者。使用混合效应累积对数模型和广义估计方程（GEE）模型来模拟这两个 condom 指标随时间的变化，同时控制人口统计学因素、UNAIDS 艾滋病毒知识、安全性行为自我效能感和伴侣沟通。
结果：由经过培训的社区志愿者实施的这种同伴小组干预措施增加了在时间 2 和 3 时的两个 condom 使用指标。在去除非显著因素的最终调整模型中，与对照组相比，最近两个月的 condom 使用量增加[时间 2：调整后的优势比（AOR）=1.59（1.15，2.21）；时间 3：AOR 2.01（1.23，3.30）]。同样，与对照组相比，最近一次性行为时使用 condom 的比例也有所增加[时间 2：AOR=1.48（1.08，2.03）；时间 3：AOR 1.81（1.13，2.90）]。还描述了其他 condom 使用增加的显著预测因素。尽管该干预措施提高了 UNAIDS 艾滋病毒知识，但知识并不能预测 condom 使用。
结论：在这项社区参与的实施研究中，由经过培训的社区志愿者提供的基于证据的同伴小组艾滋病毒预防方案增加了 condom 的使用，当由经过培训的社区志愿者提供时。社区拥有和由经过培训的志愿者提供的方案提供了一种创新且具有成本效益的策略，可以满足撒哈拉以南非洲地区持续的艾滋病毒预防需求，而不会给卫生系统带来过重负担。
试验注册：ClinicalTrials.gov NCT02765659 于 2016 年 5 月 6 日注册。
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