Background
Methods/design
Study site and population
Specific aims
Aim 1, testing
Aim 2, linkage
Aim 3, retention
Aim 4, mechanisms
Community randomization
Intervention design
Social barriers to TasP | ||||
---|---|---|---|---|
CM domains | Stigma related to testing, care, and treatment | Increased knowledge (diminish fears) about testing and treatment | Gender norms around testing and treatment | Social support around testing and treatment |
Building shared concerns and community consciousness | *2-Day intensive and single session workshops -focus on community stigma around testing/treatment *Door to door outreach *Digital stories and film screening *Engaging with clinic staff | *Street theater-focused on barriers to testing/treatment *Digital stories and films on testing and care experiences *Door to door outreach *Educational events | *2-Day and intensive and single session workshops on gender norms and the benefits/barriers to men engaging in testing and care *Street theater addressing gender norms | *2-Day intensive and single session group workshops-focused on community barriers to testing and treatment *Door to door outreach *Digital stories screening |
Engaging leadership and stakeholders (includes traditional leaders, religious leaders, clinic leaders, other community stakeholders) | *Engaging leaders around importance of TasP and barriers in community *Intensive workshops with leaders on HIV stigma, testing/treatment *Pursuing leadership commitments to achieving village testing and treatment targets (goal setting) | *Engaging leaders around importance of TasP and barriers in community *Monthly 1-day small group workshops focused on benefits of testing and treatment in community | *Engaging leaders around the importance of men engaging in health care *Seek support from leadership to enter places of work, taverns, places where men congregate | *Identifying home based care support groups in CAT development *Engaging leaders in creating support networks for testing and treatment as a community benefit *Goal setting with leadership |
Orgs/networks (includes NGOs, CBOs, CATs, other family or community groups/networks) | *Working with the key groups to openly support and include testing and treatment in their work in the communities | *Working with key groups to understand how testing and care can improve community well-being *Message dissemination through networks. | *Working with the key groups (employers, small businesses, sport teams, etc..) to support engagement of men in testing/care *Dialogues with church leaders addressing support for male testing/care | *Identifying home-based care groups and PLWH in CAT development *Partnering with support and treatment networks *Founding community support groups |
Collective action | *Murals that address stigma related to testing and treatment *Events to support testing campaigns/treatment access *Encouraging Tsima members and affiliates to HIV test together | *Soccer tournaments that highlight importance of testing and treatment *Events to support testing campaigns/treatment access *Home education (open house) events for networks/groups | *Community events/forums that address gender norms and accessing HIV care *Murals that address gender norms and HIV care | *Community events conducted by CATS, PLWH, and home-based care groups to increase community support around TaSP *Encouraging Tsima members and affiliates to HIV test together |
Social cohesion | *Visible community support (events/forums) to reduce stigma–working with PLWH *Community events to dialogue around how stigma affects the community and how communities can respond | *Identifying home based care groups and PLWH in CAT development–providing safe space for discussion and support *Events to support stronger care and treatment networks | *Dialogues with men’s groups or associations–addressing male support for testing/care. *Building CATs with men, including men LWH | *Work with home-based care and CATS to establish PLWH support networks *Extend networks and activities to families *Join CATs, local leaders, and clinic staff in testing and treatment strategies. |
Intervention monitoring
Data collection
Study measures
Primary exposure
Domain | Instrument/measure | Data source and frequency |
---|---|---|
Primary exposure | ||
Village | Village of residence (binary; intervention vs. control village) | HDSS-annual |
Primary outcomes | ||
Testing uptake (aim 1) | Binary: tested/untested past 12 months, among HIV-negative or unknown status residents | Electronic health facility records-ongoing |
Binary: known HIV status–either confirmed positive or tested within the last 12 months | Electronic health facility records-ongoing | |
Linkage to HIV care (aim 2) | Binary: received baseline CD4 results and evidence of follow-up care (additional CD4, viral load, or treatment initiation) within 3 months of testing HIV positive | Electronic health facility records-ongoing |
Binary: treatment initiation within 3 months of positive diagnosis among those eligible for ART | Electronic health facility records-ongoing | |
Retention in HIV care (aim 3) | Binary: HIV patients on or initiating ART who have no more than a 90-day gap in medication received in the 12-month period (no defaulting). | Electronic health facility records-ongoing |
Binary: HIV patients not ART eligiblea who have a repeat CD4 test 6–12 months after initial CD4 | Electronic health facility records-ongoing | |
Meditator/mechanism | ||
Community mobilization | Six domains of community mobilization measure [53] | Population-based surveys (years 1 and 5) |
Covariates | ||
Demographics | Age, SES, gender, migration status | HDSS-annual |
Social norms | Population-based surveys (years 1 and 5) | |
Secondary outcomes | ||
Testing (aim 1) | Median CD4 of people initiating ART (to explore earlier testing, entry into care) | Electronic health facility records-ongoing |
Re-engagement in care (aims 2 and 3) | Patients out of care (not retained) who are re-engaged in care (have a CD4 test/initiate or re-initiate treatment). | Electronic health facility records-ongoing |
Viral suppression | Proportion of residents with viral load <400 copies/ml | Electronic health facility records-ongoing |
Secondary exposure | ||
Intervention coverage | Reported exposure to intervention events | Population-based surveys (years 1 and 5) |
Primary outcomes
Mediators: community mobilization
Analysis
Power
Outcomes: proportion of population | Current estimate | Intervention group target | Minimum detectable difference (proportion) |
---|---|---|---|
Testing; tested in past 12 months | 35% | 60% | 19% |
Linkage; undergoing CD4 staging within 3 months of positive test | 65% | 85% | 18% |
Linkage; eligible for ART who initiate treatment within 3 months | 60% | 80% | 19% |
Retention; HIV positive who remain in care at 12 months | 50% | 70% | 19% |