دورية أكاديمية
Understanding mechanisms of impact from community-led delivery of HIV self-testing: Mediation analysis of a cluster-randomised trial in Malawi.
| العنوان: | Understanding mechanisms of impact from community-led delivery of HIV self-testing: Mediation analysis of a cluster-randomised trial in Malawi. |
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| المؤلفون: | Indravudh PP; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Terris-Prestholt F; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland., Neuman M; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom., Kumwenda MK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Chilongosi R; Population Services International Malawi, Lilongwe, Malawi., Johnson CC; Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland.; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom., Hatzold K; Population Services International, Washington, District of Columbia, United States of America., Corbett EL; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom., Fielding K; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. |
| المصدر: | PLOS global public health [PLOS Glob Public Health] 2022 Oct 27; Vol. 2 (10), pp. e0001129. Date of Electronic Publication: 2022 Oct 27 (Print Publication: 2022). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 9918283779606676 Publication Model: eCollection Cited Medium: Internet ISSN: 2767-3375 (Electronic) Linking ISSN: 27673375 NLM ISO Abbreviation: PLOS Glob Public Health Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: San Francisco, California : Public Library of Science, [2021]- |
| مستخلص: | Community HIV strategies are important for early diagnosis and treatment, with new self-care technologies expanding the types of services that can be led by communities. We evaluated mechanisms underlying the impact of community-led delivery of HIV self-testing (HIVST) using mediation analysis. We conducted a cluster-randomised trial allocating 30 group village heads and their catchment areas to the community-led HIVST intervention in addition to the standard of care (SOC) or the SOC alone. The intervention used participatory approaches to engage established community health groups to lead the design and implementation of HIVST campaigns. Potential mediators (individual perceptions of social cohesion, shared HIV concern, critical consciousness, community HIV stigma) and the outcome (HIV testing in the last 3 months) were measured through a post-intervention survey. Analysis used regression-based models to test (i) intervention-mediator effects, (ii) mediator-outcome effects, and (iii) direct and indirect effects. The survey included 972 and 924 participants in the community-led HIVST and SOC clusters, respectively. The community-led HIVST intervention increased uptake of recent HIV testing, with no evidence of indirect effects from changes in hypothesised mediators. However, standardised scores for community cohesion (adjusted mean difference [MD] 0.15, 95% CI -0.03 to 0.32, p = 0.10) and shared concern for HIV (adjusted MD 0.13, 95% CI -0.02 to 0.29, p = 0.09) were slightly higher in the community-led HIVST arm than the SOC arm. Social cohesion, community concern, and critical consciousness also apparently had a quadratic association with recent testing in the community-led HIVST arm, with a positive relationship indicated at lower ranges of each score. We found no evidence of intervention effects on community HIV stigma and its association with recent testing. We conclude that the intervention effect mostly operated directly through community-driven service delivery of a novel HIV technology rather than through intermediate effects on perceived community mobilisation and HIV stigma. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2022 Indravudh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) |
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| معلومات مُعتمدة: | 001 International WHO_ World Health Organization; 200901/Z/16/Z United Kingdom WT_ Wellcome Trust |
| تواريخ الأحداث: | Date Created: 20230324 Latest Revision: 20230809 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC10021599 |
| DOI: | 10.1371/journal.pgph.0001129 |
| PMID: | 36962622 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2767-3375 |
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| DOI: | 10.1371/journal.pgph.0001129 |