A community mobilisation intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomised controlled trial

Lippman, Sheri A.; Pettifor, Audrey; Dufour, Mi‐Suk Kang; Kabudula, Chodziwadziwa Whiteson; Twine, Rhian; Peacock, Dean; Mathebula, Rhandzekile; Julien, Aimée; West, Robin; Neilands, Torsten B.; Wagner, Ryan G.; Gottert, Ann; Gómez‐Olivé, F. Xavier; Rebombo, Dumisani; Haberland, Nicole; Pulerwitz, Julie; Majuba, Louis Pappie; Tollman, Stephen; Kahn, Kathleen

doi:10.1016/s2352-3018(22)00192-8

Cited by 8 publications

(11 citation statements)

References 24 publications

(39 reference statements)

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“…The Community Mobilisation for Treatment as Prevention trial was known locally as Tsima ra rihanyu (meaning working together to plough the fields for health). 3 HIV testing improved in both groups for both men and women in the study, with modestly higher relative changes in the community mobilisation group. Linkageto-care improvements were noted only among women in the community mobilisation group.…”

Section: Comment E598mentioning

confidence: 78%

“…The results suggested a modest benefit towards achieving the UNAIDS 90-90-90 (now 95-95-95) indicators by 2030, with women benefiting in all elements but men only benefiting in testing. 3 The study is among a family of sub-Saharan African treatment-as-prevention trials that applied fast track HIV testing and ART-based care in local settings. All included community mobilisations to varying extents.…”

Section: Comment E598mentioning

confidence: 99%

“…All included community mobilisations to varying extents. The ANRS 12249 TaSP, SEARCH, Botswana Ya Tsie, and HPTN 071 (PopART) trials had community-level HIV transmission outcomes, [3][4][5] whereas other trials such as Community Mobilisation for Treatment as Prevention, Project Shikamana, 6 and MaxART 7 sought to improve coverage and viral suppression. All these studies had successes and disappointments and one might well ask, where do we go from here?…”

Section: Comment E598mentioning

confidence: 99%

“…8 Second, treatment fatigue might have been seen in the trial by Lippman and colleagues, as both community mobilisation and control group communities saw a decline in retention rates over the 3-year study period. 3 Making it easier to obtain ART and maintain usage might require programmatic innovation, use of longacting injectable antiretroviral drugs, and supply chain improvements to avoid drug stockouts. 9 Third, combination approaches are essential, as no single innovation will be transformative.…”

Section: Comment E598mentioning

confidence: 99%

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Community mobilisation to achieve HIV testing and care goals

Vermund

2022

The Lancet HIV

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Section: Comment E598mentioning

confidence: 78%

Section: Comment E598mentioning

confidence: 99%

Section: Comment E598mentioning

confidence: 99%

Section: Comment E598mentioning

confidence: 99%

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Community mobilisation to achieve HIV testing and care goals

Vermund

2022

The Lancet HIV

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“…Twelve RCTs examined the role of mobilization [31][32][33][34][35][36][37][38][39][40][41][42][43] (Table 1). Nine RCTs were in Africa [31,33,35,36,[38][39][40][41][42][43] and 3 were in the Americas [32,34,37]. Twelve focused on general population heterosexual adult men and women and while 1 focused on women.…”

Section: Mobilizationmentioning

confidence: 99%

Demand creation for HIV testing services: A systematic review and meta-analysis

et al. 2023

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Background HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, “Which demand creation strategies are effective for enhancing uptake of HTS?” focused on populations globally. Methods and findings The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane’s risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. Conclusions Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.

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