Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial

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dc.contributor.authorLippman, Sheri A
dc.contributor.authorPettifor, Audrey
dc.contributor.authorRebombo, Dumisani
dc.contributor.authorJulien, Aimée
dc.contributor.authorWagner, Ryan G
dc.contributor.authorKang Dufour, Mi-Suk
dc.contributor.authorKabudula, Chodziwadziwa Whiteson
dc.contributor.authorNeilands, Torsten B
dc.contributor.authorTwine, Rhian
dc.contributor.authorGottert, Ann
dc.contributor.authorGómez-Olivé, F Xavier
dc.contributor.authorTollman, Stephen M
dc.contributor.authorSanne, Ian
dc.contributor.authorPeacock, Dean
dc.contributor.authorKahn, Kathleen
dc.date.accessioned2021-10-08T07:04:15Z
dc.date.available2021-10-08T07:04:15Z
dc.date.issued2017
dc.description.abstractAbstract Background HIV transmission can be decreased substantially by reducing the burden of undiagnosed HIV infection and expanding early and consistent use of antiretroviral therapy (ART). Treatment as prevention (TasP) has been proposed as key to ending the HIV epidemic. To activate TasP in high prevalence countries, like South Africa, communities must be motivated to know their status, engage in care, and remain in care. Community mobilization (CM) has the potential to significantly increase uptake testing, linkage to and retention in care by addressing the primary social barriers to engagement with HIV care—including poor understanding of HIV care; fear and stigma associated with infection, clinic attendance and disclosure; lack of social support; and gender norms that deter men from accessing care. Methods/design Using a cluster randomized trial design, we are implementing a 3-year-theory-based CM intervention and comparing gains in HIV testing, linkage, and retention in care among individuals residing in 8 intervention communities to that of individuals residing in 7 control communities. Eligible communities include 15 villages within a health and demographic surveillance site (HDSS) in rural Mpumalanga, South Africa, that were not exposed to previous CM efforts. CM activities conducted in the 8 intervention villages map onto six mobilization domains that comprise the key components for community mobilization around HIV prevention. To evaluate the intervention, we will link a clinic-based electronic clinical tracking system in all area clinics to the HDSS longitudinal census data, thus creating an open, population-based cohort with over 30,000 18–49-year-old residents. We will estimate the marginal effect of the intervention on individual outcomes using generalized estimating equations. In addition, we will evaluate CM processes by conducting baseline and endline surveys among a random sample of 1200 community residents at each time point to monitor intervention exposure and community level change using validated measures of CM. Discussion Given the known importance of community social factors with regard to uptake of testing and HIV care, and the lack of rigorously evaluated community-level interventions effective in improving testing uptake, linkage and retention, the proposed study will yield much needed data to understand the potential of CM to improve the prevention and care cascade. Further, our work in developing a CM framework and domain measures will permit validation of a CM conceptual framework and process, which should prove valuable for community programming in Africa. Trial Registration NCT02197793 Registered July 21, 2014.
dc.identifier.apacitationLippman, S. A., Pettifor, A., Rebombo, D., Julien, A., Wagner, R. G., Kang Dufour, M., ... Kahn, K. (2017). Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. <i>Implementation Science</i>, 12(1), 174 - 177. http://hdl.handle.net/11427/34462en_ZA
dc.identifier.chicagocitationLippman, Sheri A, Audrey Pettifor, Dumisani Rebombo, Aimée Julien, Ryan G Wagner, Mi-Suk Kang Dufour, Chodziwadziwa Whiteson Kabudula, et al "Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial." <i>Implementation Science</i> 12, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34462en_ZA
dc.identifier.citationLippman, S.A., Pettifor, A., Rebombo, D., Julien, A., Wagner, R.G., Kang Dufour, M., Kabudula, C.W. & Neilands, T.B. et al. 2017. Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. <i>Implementation Science.</i> 12(1):174 - 177. http://hdl.handle.net/11427/34462en_ZA
dc.identifier.issn1748-5908
dc.identifier.ris TY - Journal Article AU - Lippman, Sheri A AU - Pettifor, Audrey AU - Rebombo, Dumisani AU - Julien, Aimée AU - Wagner, Ryan G AU - Kang Dufour, Mi-Suk AU - Kabudula, Chodziwadziwa Whiteson AU - Neilands, Torsten B AU - Twine, Rhian AU - Gottert, Ann AU - Gómez-Olivé, F Xavier AU - Tollman, Stephen M AU - Sanne, Ian AU - Peacock, Dean AU - Kahn, Kathleen AB - Abstract Background HIV transmission can be decreased substantially by reducing the burden of undiagnosed HIV infection and expanding early and consistent use of antiretroviral therapy (ART). Treatment as prevention (TasP) has been proposed as key to ending the HIV epidemic. To activate TasP in high prevalence countries, like South Africa, communities must be motivated to know their status, engage in care, and remain in care. Community mobilization (CM) has the potential to significantly increase uptake testing, linkage to and retention in care by addressing the primary social barriers to engagement with HIV care—including poor understanding of HIV care; fear and stigma associated with infection, clinic attendance and disclosure; lack of social support; and gender norms that deter men from accessing care. Methods/design Using a cluster randomized trial design, we are implementing a 3-year-theory-based CM intervention and comparing gains in HIV testing, linkage, and retention in care among individuals residing in 8 intervention communities to that of individuals residing in 7 control communities. Eligible communities include 15 villages within a health and demographic surveillance site (HDSS) in rural Mpumalanga, South Africa, that were not exposed to previous CM efforts. CM activities conducted in the 8 intervention villages map onto six mobilization domains that comprise the key components for community mobilization around HIV prevention. To evaluate the intervention, we will link a clinic-based electronic clinical tracking system in all area clinics to the HDSS longitudinal census data, thus creating an open, population-based cohort with over 30,000 18–49-year-old residents. We will estimate the marginal effect of the intervention on individual outcomes using generalized estimating equations. In addition, we will evaluate CM processes by conducting baseline and endline surveys among a random sample of 1200 community residents at each time point to monitor intervention exposure and community level change using validated measures of CM. Discussion Given the known importance of community social factors with regard to uptake of testing and HIV care, and the lack of rigorously evaluated community-level interventions effective in improving testing uptake, linkage and retention, the proposed study will yield much needed data to understand the potential of CM to improve the prevention and care cascade. Further, our work in developing a CM framework and domain measures will permit validation of a CM conceptual framework and process, which should prove valuable for community programming in Africa. Trial Registration NCT02197793 Registered July 21, 2014. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Implementation Science LK - https://open.uct.ac.za PY - 2017 SM - 1748-5908 T1 - Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial TI - Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial UR - http://hdl.handle.net/11427/34462 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34462
dc.identifier.vancouvercitationLippman SA, Pettifor A, Rebombo D, Julien A, Wagner RG, Kang Dufour M, et al. Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. Implementation Science. 2017;12(1):174 - 177. http://hdl.handle.net/11427/34462.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceImplementation Science
dc.source.journalissue1
dc.source.journalvolume12
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s13012-016-0541-0
dc.subject.otherCluster randomized trial
dc.subject.otherCommunity mobilization
dc.subject.otherEngagement in care
dc.subject.otherHIV testing
dc.subject.otherRetention in care
dc.subject.otherSouth Africa
dc.subject.otherTreatment as prevention
dc.subject.otherAdolescent
dc.subject.otherAdult
dc.subject.otherCluster Analysis
dc.subject.otherEarly Diagnosis
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherMiddle Aged
dc.subject.otherPatient Acceptance of Health Care
dc.subject.otherPatient Compliance
dc.subject.otherRural Health
dc.subject.otherSouth Africa
dc.subject.otherYoung Adult
dc.titleEvaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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