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Cited by 23HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV/AIDS Impact and Responses

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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

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Smith Fawzi, Mary C, Siril, Hellen, Liu, Yuanyuan, McAdam, Keith, Ainebyona, Donald, McAdam, Elspeth, Somba, Magreat, Oljemark, Kicki, Mleli, Neema, Lienert, Jeffrey, Andrew, Irene, Haberlen, Sabina, Simwinga, Alice, Todd, Jim, Makongwa, Samwel, Li, Nan, Kaaya, Sylvia·2019·BMJ Global Health
DOI 10.1136/bmjgh-2018-000946PMC PMC6528754
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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.

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Metadata

Authors
Smith Fawzi, M. C., Siril, H., Liu, Y., McAdam, K., Ainebyona, D., McAdam, E., Somba, M., Oljemark, K., Mleli, N., Lienert, J., Andrew, I., Haberlen, S., Simwinga, A., Todd, J., Makongwa, S., Li, N., & Kaaya, S.
Affiliations
  • Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  • Management and Development for Health (TZ)
  • Harvard University (US)
  • NAMWEZA Centre, London, UK
  • Muhimbili University of Health and Allied Sciences (TZ)
  • Johns Hopkins University (US)
  • Ministry of Health and Social Welfare (TZ)
  • London School of Hygiene & Tropical Medicine (GB)
ORCID
Venue
BMJ Global Health
Publisher
BMJ
Published
2019-05
Volume
4
Issue
3
Pages
e000946
ISSN
2059-7908 (ISSN-L)
DOI
10.1136/bmjgh-2018-000946
PMC
PMC6528754
OpenAlex
W2944289592
Cited by
23
References
2
Citations by year
2026: 3 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 8 · 2021: 2 · 2020: 5
FWCI
2.88
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Centers for Disease Control and Prevention (TZ/UG.08.0147)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
Keywords
people living with HIV, HIV prevention, social networks, intimate partner violence, HIV stigma, depression, HIV risk behavior, self-efficacy, self-esteem, HIV service uptake, sexual and reproductive health and rights, Dar es Salaam

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