You are here

  • Home
  • Archive
  • Volume 4, Issue 3
  • Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania

Article Text

Article menu

Download PDFPDF

XML
Research
Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania
  1. Mary C Smith Fawzi1,
  2. Hellen Siril2,
  3. Yuanyuan Liu1,
  4. Keith McAdam3,
  5. Donald Ainebyona4,
  6. Elspeth McAdam3,
  7. Magreat Somba4,
  8. Kicki Oljemark3,
  9. Neema Mleli4,
  10. Jeffrey Lienert1,
  11. Irene Andrew2,
  12. Sabina Haberlen5,
  13. Alice Simwinga6,
  14. Jim Todd7,8,
  15. Samwel Makongwa4,
  16. Nan Li9,
  17. Sylvia Kaaya4
  1. 1Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Management and Development for Health, Dar es Salaam, Tanzania
  3. 3NAMWEZA Centre, London, UK
  4. 4Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  5. 5Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6Department of Health, Dar es Salaam, Tanzania
  7. 7Population Health, London School of Hygiene and Tropical Medicine, London, UK
  8. 8Kilimanjaro Christian Medical University College, Moshi, Tanzania
  9. 9Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Mary C Smith Fawzi; mary_smith-fawzi{at}hms.harvard.edu

Abstract

Introduction NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members.

Methods A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV.

Results For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002).

Conclusion These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions.

Trial registration number NCT01693458.

  • HIV prevention
  • people living with HIV
  • social networks
  • behavioural intervention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2018-000946

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Handling editor Seye Abimbola

    • Contributors MCSF conceptualised and designed the study, drafted the initial version of the manuscript, participated in the statistical analysis and interpreted the findings. HS participated in drafting the manuscript, directed the study activities in the field and interpreted the findings. NL, JL and YL participated in drafting the manuscript, conducted the statistical analysis and interpreted the findings. KM, EM, KO, SH, JT and SK conceptualised and designed the study, participated in drafting the manuscript and interpreted the findings. DA participated in drafting the manuscript, managed field operations and interpreted the findings. MS, NM and SM participated in drafting the manuscript, collected data in the field and interpreted the findings. IA and AS participated in drafting the manuscript, assisted in directing the study activities in the field and interpreted the findings. All authors agree to be accountable for all aspects of the work in terms of accuracy and integrity and have approved the final version of the manuscript as submitted.

    • Funding This research study was funded by the US Centers for Disease Control and Prevention (CDC) (Grant No: TZ/UG.08.0147). Technical and professional staff at the US CDC provided input into the study design and analysis for this manuscript. YL was supported by the UTHealth Innovation for Cancer Prevention Research Training Program Predoctoral or Postdoctoral Fellowship (Cancer Prevention and Research Institute of Texas, Grant No RP160015) at the time of submission.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the Cancer Prevention and Research Institute of Texas.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Institutional Review Boards (IRB) at the Harvard T H Chan School of Public Health (HSPH), Muhimbili University of Health and Allied Sciences (MUHAS) and the National Institute for Medical Research (NIMR) in Tanzania.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data are freely available from the corresponding author based on request.