Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of theNAMWEZAintervention in Dar es Salaam, Tanzania

Abstract

IntroductionNAMWEZA 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.MethodsA 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.ResultsFor 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).ConclusionThese 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 numberNCT01693458.

Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania

“…The peer-mother interactive programme was built upon the foundations of the NAMWEZA approach, pioneered by researchers in Uganda and Tanzania [28]. NAMWEZA (a term derived from Swahili words meaning "Yes, together we can") is a peer-based participatory approach built on the framework and principles of appreciative inquiry, which entails the use of appreciative conversations and relationships to influence attitudes, behaviours and practices [28,29].…”

Evaluating spillover of HIV knowledge from study participants to their network members in a stepped-wedge behavioural intervention in Tanzania

“…For more information on the study design, we direct interested readers to Smith Fawzi et al , 2019. 28 …”

“…27 The trial recruited PLH to serve as change agents (CAs) and to reach out to their social network members (NMs) about knowledge of HIV and safer sexual practices. 28 Our goals in this study were threefold: (1) to understand how the NMs differed from their CAs, (2) understand correlates of dropout for the NMs and (3) to understand by what method HIV knowledge transferred to the NMs from the CAs. Understanding how the information and behaviours are shared within social networks will allow HIV researchers and others to take advantage of this knowledge and improve on prevention interventions in the future.…”

“…For more information on the study design, we direct interested readers to Smith Fawzi et al, 2019. 28 The NMs did not receive any intervention at any point during the study. Rather, their intervention status flowed from the intervention status of their CAs.…”

Agents of change: Comparing HIV-related risk behavior of people attending ART clinics in Dar es Salaam with members of their social networks

“…A cross-sectional analysis is reported of baseline data from a stepped wedge randomized controlled trial of an HIV prevention intervention conducted from February 2012 to January 2014 described elsewhere [25,28]. PLH volunteers were recruited and enrolled from an HIV care and treatment clinic and its satellite clinics in the Kinondoni Municipality of Dar es Salaam, Tanzania.…”