Feasibility of conducting HIV combination prevention interventions in fishing communities in Uganda: A pilot cluster randomised trial.

Monica O Kuteesa,Andrew Abaasa,Janet Seeley,Anatoli Kamali,Helen A Weiss,Rebecca N Nsubuga,Rob Newton,Stephen Nash

doi:10.1371/journal.pone.0210719

Abstract

ObjectiveWe assessed feasibility of an HIV-combination-prevention trial among fishing communities in Uganda.DesignCluster randomised trial in four fishing communities on Lake Victoria, Uganda. Two intervention communities received a combination-prevention-package (behaviour change communication, condom promotion, HIV testing, voluntary male medical circumcision and referral for anti-retroviral therapy if HIV-positive). All four communities received routine government HIV care services.MethodsUsing household census data we randomly selected a cohort of consenting residents aged ≥18 years. A baseline sero-survey in July 2014 was followed by two repeat surveys in March and December 2015. We measured uptake of HIV prevention methods, loss-to-follow-up and HIV incidence, accounting for multistage survey design.ResultsA total of 862 participants were enrolled and followed for 15 months. Participation was 62% and 74% in the control and intervention arms respectively; Overall loss to follow up (LTFU) was 21.6% and was similar by arm. Self-reported abstinence/faithfulness increased between baseline and endline in both arms from 53% to 73% in the control arm, and 55% to 67% in the intervention arm. Reported condom use throughout the study period was 36% in the intervention arm vs 28% in the control arm; number of male participants reporting circumsicion in both arms from 58% to 79% in the intervention arm, and 39% to 46% in the control arm. Independent baseline predictors of loss-to-follow-up were: being HIV positive, residence in the community for <1 year, younger age, living in an urban area, and being away from the area for >1 month/yearConclusionsRecruitment and retention of participants in longitudinal trials in highly mobile HIV fishing communities is challenging. Future research should investigate modes for locating and retaining participants, and delivery of HIV-combination prevention.

Highlights

With major advances in HIV treatment and prevention, the number of new HIV infections among adults globally declined by an estimated 11%, from 3.4 million in 1996 to 1.8 million in 2017 [1]
Some studies have demonstrated the feasibility of achieving the UNAIDS 2020 target: 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, 90% of all people receiving antiretroviral therapy will have viral suppression 90-90-90) [3,4]
Other ongoing combination prevention trials in eastern and southern Africa suggest that implementing effective HIV treatment and prevention interventions in high prevalence settings is feasible, and can be rapidly scaled to achieve the UNAIDS 90-90-90 target [7, 8]

Summary

Introduction

With major advances in HIV treatment and prevention, the number of new HIV infections among adults globally declined by an estimated 11%, from 3.4 million in 1996 to 1.8 million in 2017 [1]. HIV incidence remains high in many settings, including eastern and southern Africa. An estimated 43% of new HIV infections globally occur in this region [1]. Combination prevention strategies, among key populations, are needed for a sustained impact on global HIV incidence, and to alleviate the economic burden in low- and middle-income countries [5]. Other ongoing combination prevention trials in eastern and southern Africa suggest that implementing effective HIV treatment and prevention interventions in high prevalence settings is feasible, and can be rapidly scaled to achieve the UNAIDS 90-90-90 target [7, 8]

Methods

Results

Conclusion