Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe Simon Gregson Saina Adamson Spiwe Papaya Jephias Mundondo Constance A Nyamukapa Peter R Mason Geoffrey P Garnett Stephen K Chandiwana Geoff Foster Roy M Anderson 10.1371/journal.pmed.0040102 https://plos.figshare.com/articles/dataset/Impact_and_Process_Evaluation_of_Integrated_Community_and_Clinic_Based_HIV_1_Control_A_Cluster_Randomised_Trial_in_Eastern_Zimbabwe/152427 <div><h3>Background</h3><p>HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels.</p> <h3>Methods and Findings</h3><p>We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92–1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24–0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28–0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21–5.12).</p> <h3>Conclusions</h3><p>Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population sub-groups.</p> </div> 2007-03-27 00:40:27 clinic-based hiv-1 cluster-randomised zimbabwe