Introduction
Methods
-
To what extent does CM impact on measurable HIV-related prevention outcomes?
-
Is there a significant relationship between the implementation of programmes with a CM component and biomedical, behavioural and social outcomes? If so, what is the direction of this relationship for each outcome?
-
Under what programmatic conditions (target population and intervention components) is CM most successful?
-
What are the methodological challenges of evaluating and synthesising evidence on CM?
Selection
-
Reported community-based initiatives (as opposed to health facility-based medical interventions) that engaged one or more community groups in concrete participatory activities. Studies should have reported modes of CM that foster meaningful community connections.
-
Evaluated the intervention in terms of at least one quantifiable biomedical (incidence and/or prevalence of HIV-1, HSV-2 and bacterial STI) or behavioural (reported condom use, reported health-service use, and HIV test-taking) outcome.
-
Evaluated outcomes with reference to a comparator or control, irrespective of research design.
Data Extraction and Synthesis
Reference | Intervention name (if any) and setting | Study designa and length | Target group, sample size at baseline | Comparator | Intervention components | Outcome/resultsb
| ||
---|---|---|---|---|---|---|---|---|
Biomedical | Behavioural | Social | ||||||
Doyle et al. [50] | MEMA kwa Vijana 10 rural communities in Mwanza, rural Tanzania | RCT Average exposure 5.4 years prior survey | Adolescents aged 14 years or more at programme onset. N = 13814 (males: nI = 3807, nC = 3493; females: nI = 3276, nC = 3238)c
| 10 randomised comparison communities with no intervention | Participatory school programme. Training and provision of health workers for youth-friendly SRH services. Community-based condom social marketing by youth. Initial community mobilisation. | No difference between intervention and control groups in HIV prevalence (males aPR 0.91, 95 % CI 0.50–1.65; females aPR 1.07, 95 % CI 0.68–1.67) or in HSV-2 (males aPR 0.94, 95 % CI 0.77–1.15; females aPR 0.96, 95 % CI 0.87–1.06). No difference in prevalence of active syphilis (males aPR 1.1, 95 % CI 0.72–1.72; females aPR 0.91, 95 % CI 0.65–1.28), chlamydia (males aPR 1.24, 95 % CI 0.66–2.33; females aPR 1.27, 95 % CI 0.87–1.86), and gonorrhoea (males aPR 0.71, 95 % CI 0.21–2.41; females aPR 0.73, 95 % CI 0.20–2.63). | Reported condom use at last sex with non-regular partner increased among females (aPR 1.34, 95 % CI 1.07–1.69) with no difference among males (aPR 1.15, 95 % CI 0.97–1.36). No significant differences in reported condom use at last sex (males aPR 1.19, 95 % CI 0.91–1.54; females aPR1.27, 95 % CI 0.97–1.67). | NA |
Kamali et al. [54] | Masaka district, Uganda 12 communities (groups A and B) | RCT Median follow-up of 3.6 years. | All adults (13 years or older). nA = 4931 nB = 4787, nC = 4836 | 6 communities received routine government health facilities with general community development activities (group C, control) | Group A. IEC intervention: knowledge acquisition, skill development, motivational support and attitudes development. Community-level: group meetings, one-to-one discussions, information leaflets, local drama, videos. Group B. A + STI intervention: trained health workers in STI syndromic management. Consistent supply of drugs and supervision, coupled with community-based STI health education. Group C (control). Community development and general health-related issues: self-support groups and clubs, home-based care, and general health promotion seminars. | No difference between intervention (A/B) and control (C) groups in HIV-1 incidence (A vs C, aIRR 0.94, 95 % CI 0.60–1.45, p = 0.72; B vs C, aIRR 1.00, 95 % CI 0.63–1.58, p = 0.98). Lower HSV2 incidence in group A than in group C (aIRR 0.65, 95 % CI 0.53–0.80, p = 0.003); no difference between group B and C (aIRR 1.00, 95 % CI 0.54–1.85, p = 0.99). No difference between group A and group C in active syphilis (aIRR 1.02, 95 % CI 0.66–1.57, p = 0.92) and high titre active syphilis (aIRR 1.03, 95 % CI 0.59–1.79, p = 0.90). Lower incidence in group B than in group C of active syphilis (aIRR 0.77, 95 % CI 0.61–0.96, p = 0.029) and high titre active syphilis (aIRR 0.52, 95 % CI 0.27–0.98, p = 0.044). Lower gonorrhoea prevalence in group B than in group C (aPR 0.25, 0.10–0.64, p = 0.013), but no difference between group A and group C (aPR 0.64, 95 % CI 0.25–1.59, p = 0.26). No difference between intervention and control groups for chlamydia prevalence. | No differences in condom use with last partner in group A compared with C (aPR = 1.12, 95 % CI 0.99-1.25, p = 0.57). Increase in condom use with last casual partner in group B compared with C (aPR = 1.27, 95 % CI 1.02–1.56, p = 0.036). No difference in reported ever condom use (A vs C, aPR = 0.92, 95 % CI 0.68–1.26, p = 0.54; B vs C, aPR = 1.10, 95 % CI 0.95–1.26, p = 0.16). | NA |
Cowan et al. [49] | Regai Dzive Shiri 15 communities in rural Zimbabwe | RCT 4 years | 18–22 year-olds Intervention = 3381 Control = 3410 | 15 randomised control villages with delayed intervention. Matched controls for each cohort | Participatory youth programme via peer educators. Programme for parents and community stakeholders aimed at enhancing knowledge, communication and community support towards adolescents. Training for nurses and other clinic staff. | No difference between intervention and control groups in HIV or HSV-2 prevalence in men (aOR 1.20, 95 % CI 0.66–2.18; aOR 1.23, 95 % CI 0.69–2.18) and women (aOR 1.15, 95 % CI 0.81–1.54; aOR 1.24, 95 % CI 0.93–1.65). | No difference between intervention and control groups in reported condom use at last sex in men (aOR 1.03, 95 % CI 0.83–1.29) and women (aOR 0.93, 95 % CI 0.72–1.20). No difference in clinic attendance in men (aOR 0.99, 95 % CI 0.76–1.29) and women (aOR 0.98, 95 % CI 0.76–1.28). | NA |
Gregson et al. [52] | Manicaland 6 communities in Manicaland, Zimbabwe | RCT 3 years | Males (17–54 years) and females (15–44 years) Intervention = 4792 Control = 4662 | 6 matched control communities with standard government services | Peer education and condom distribution: sex workers, male clients and general community. Income-generating projects (withdrawn). Strengthened syndromic management of STI. Open days with HIV/AIDS IEC activities. | No difference between intervention communities and control communities in HIV incidence (aIRR 1.27, 95 % CI 0.92–1.75, p = 0.12). | Reported unprotected sex with casual partners higher in intervention than in control communities (males aPOR 1.46, CI 1.02–2.09, p = 0.039; females aPOR 6.51, CI 2.14–19.82, p = 0.001). No group differences in consistent condom use with regular partners (males aPOR 1.01, CI 0.72–1.40, p = 0.975; females aPOR 1.09, CI 0.72–1.65, p = 0.686) or treatment-seeking within 3 days of STI symptoms (males aPOR 1.13, CI 0.59–2.16, p = 0.709; females aPOR 1.14, CI 0.74–1.77, p = 0.544). | NA |
Jewkes et al. [51] | Stepping stones | RCT 6 to 8 weeks | N = 2,776 Young men (nI = 694, nC = 666) and women (nI = 715, nC = 701) aged 15 to 26 years | Control intervention: single three-hour session on HIV, safer sex and condoms. Baseline and follow-up 12 and 24 months later | Preliminary community consultation. Participatory learning approaches: critical reflection, role play and drama. 13 three-hour long sessions. 3 peer group meetings. 1 final community meeting. | No difference in HIV incidence among men and women (aIRR 0.95, 95 % CI 0.67–1.35, p = 0.78) HSV2 incidence lower in the intervention than the control group (aIRR 0.67, 95 % CI 0.46–0.97, p = 0.036) | No difference between intervention and control groups in correct condom use at last sex at 12 and 24 months in men (aOR 1.26, 95 % CI 0.92–1.74, p = 0.16; aOR 0.88, 95 % CI 0.64–1.21, p = 0.43) and women (aOR 0.95, 95 % CI 0.72–1.28 p = 0.79; aOR 0.90, 95 % CI 0.70–1.17 p = 0.45). | Men reported perpetration of intimate partner violence less frequently than controls at 12 months and 24 months (aOR 0.73, 95 % CI 0.50–1.06 p = 0.099; aOR 0.62, 95 % CI 0.38–1.01, p = 0.054), with no difference among women (aOR 0.87, 95 % CI = 0.64–1.18, p = 0.36; aOR 1.14, 95 % CI = 0.77–1.68, p = 0.51) |
Pronyk et al. [53] | IMAGE 4 villages in Limpopo, South Africa | RCT 18 months | Three cohorts: 1. Women who applied for loan (nI = 426, nC = 417; 2. 14–35 years old household co-residents (nI = 725, nC = 730); 3.Randomly selected community members (nI = 746; nC = 736) | 4 matched villages with delayed intervention. Matched controls for each cohort | Poverty-focused microfinance. Gender and HIV participatory curriculum (structured training and community mobilisation). Community mobilisation as HIV and intimate partner violence awareness, village workshops and multi stake-holder meetings, marches, partnerships and committees. | No difference between cohort 3 and control group in HIV incidence (aRR 1.06, 95 % CI 0.66–1.69). | No difference in unprotected sexual intercourse with a non-spousal partner in cohort 2 (aRR 1.02, 95 % CI 0.85–1.23) and cohort 3 (aRR 0.89, 95 % CI 0.66–1.19) relative to controls. No difference in having had an HIV test in cohort 2 (aRR 1.18, 95 % CI 0.73–1.91) and cohort 3 (aRR 1.09, 95 % CI 0.81–1.47) relative to controls. | Intimate partner violence reported less frequently in cohort 1 than in control group (aRR 0.45, 95 % CI 0.23–0.91). Cohort 1 reported higher levels of participation in social groups (aRR 1.85, 95 % CI 0·95–3·61) and collective action (aRR 2·06, 95 % CI 0.92–4.49) than control group. No difference in sense of community solidarity in times of crisis(aRR 1.65, 95 % CI 0.81–3.37) and belief of community work on common goals (aRR 1.11, 95 % CI 0.38–3.24). |
Sweat et al. [15] | Accept, HPTN 043 Communities of Tanzania (10), Zimbabwe (8) and Thailand (14) | RCT 3 years | 16–32 year-olds Clients: Tanz (nI = 6250; nC = 6733); Zimb (nI = 10,700; nC = 12,150); Thai (nI = 11,290; nC = 10,033) | Equal number of matching communities received standard clinic-based voluntary counselling and testing (SVCT) for HIV | Preliminary participatory mapping. Community mobilisation: community working groups, outreach workers activities, community-based outreach workers. Community based voluntary counselling and testing (CBVCT): accessible mobile VCT for and community based-support services after testing. | NA | Percentage of “clients” testing for HIV for the first time higher in CBVCT communities than in SVCT communities. Crude mean difference: 40.2 % (95 % CI 15.8–64.7, p = 0.019) across one pair of matched communities per country. | NA |
Coates et al. [48] | Accept, HPTN 043 | No difference HIV incidence in CBVCT than in SVCT (RRi 0.86, 95 % CI 0.73–1.02, p = 0.08). | NA | NA | ||||
Kerrigan et al. [14] | Santo Domingo and Puerto Plata in Dominican Republic | Cohort analytic 1 year | 68 FSW establishments in 2 cities N ~ 200 | Baseline and follow-up. Components 1–4 (CM) in both cities, component 5 (policy) only in Puerto Plata. Exposure to intervention vs low-exposure | 1. Solidarity and collective commitment. 2. Environmental cues. 3. Clinical services. 4. Monitoring and encouraging adherence. 5. Policy and regulation. | Prevalence of 1 or more STIs (gonorrhoea, trichomoniasis, or chlamydia) decreased in Puerto Plata (aOR 0.50, 95 % CI 0.32–0.78, p < 0.01) but had no significant changes in Santo Domingo (aOR 0.60, 95 % CI 0.35–1.03). | Consistent condom use with new clients increased in Santo Domingo, (aOR 4.21, 95 % CI 1.55–11.43, p < 0.01) but not in Puerto Plata (aOR 2.27, 95 % CI 0.47–10.84). Consistent condom use with regular partners and FSW’s observed verbal rejection of unsafe commercial sex increased in Puerto Plata (aOR 2.97, 95 % CI 1.33–6.66, p < 0.01; aOR 3.86, 95 % CI 1.96–7.58, p < 0.001) but not in Santo Domingo (aOR 1.29, 95 % CI 0.62–2.70; aOR 1.49, 95 % CI 0.81–2.73). | NA |
Gao and Wang [72] | Chengdu, Southern China | Cohort analytic 5 months | MSM N = 160 Intervention n = 80; Control n = 80 | Baseline and follow-up. Control received no exposure to intervention | Gay bar-based participatory entertainment-education. Outdoor edutainment activities to expand networks. Fostering of a caring environment. | NA | Increase in condom use among intervention group with casual partners: vaginal sex (6.1–73.5 %, p < 0.001), anal sex (4.3–76.8 %, p < 0.001) and oral sex (1.4–15.9 %, p < 0.01); with regular partners: vaginal sex (7.4–40.7 %, p < 0.001), anal sex (3.1–46.2 %, p < 0.001) and oral sex (1.5–10.3 %, p < 0.05). No differences in condom use among comparison groups. | NA |
Swendeman et al. [65] | Sonagachi-replication West Bengal, India | Cohort analytic 16 months | FSW, 1 replication community N = 216 | Baseline and 3 follow-ups within 16 months. Control community receiving standard care: STD clinic free of charge, condom promotion and peer education | Enhanced intervention including standard care plus: Rapid appraisal. STD/HIV Intervention Project. FSW community organisation. USHA multi-purpose micro-finance cooperative. Advocacy with stake-holders and power-brokers. | NA | Social support through organising and solidarity increased among intervention group (p < 0.001 across items), while it decreased among controls (p < 0.001 across items). Political participation remained stable among intervention group (p > 0.05) and increased among controls (p < 0.001) | |
Basu et al. [66] | Intervention n = 110; control n = 106 | Condom use increased more among FSW in intervention community than among controls (B = 0.3447, p = 0.002). | ||||||
Erausquin et al. [56] | Parivartan Rajahmundry, Andhra Pradesh, India | Cohort analytic 6 years: Project onset in 2004, 3 surveys: 2006, 2007, 2009/10. | FSW N = 812 | 3 time points. Comparison between no programme exposure, receptive exposure and active utilisation | Identification of social change agents among FSW. Peer education and community organisation. Traditional intervention (condom distribution, condom use promotion, etc.). Advocacy and organisation of FSW-led CBOs. | NA | Greater programme exposure related to increased probability of consistent condom use with clients (no exposure vs receptive exposure aOR 1.57, 95 % CI 1.22–2.02, p < 0.001; no exposure vs active utilisation aOR 2.03, 95 % CI 1.60–2.57, p < 0.001). Association maintained over time. | NA |
Blankenship et al. [55] | Parivartan | Case control 2 years (NA - see comparison) | N = 812 | Comparison between no programme exposure, receptive exposure and active utilisation | NA | Greater programme exposure related to increased probability of consistent condom use (no exposure vs active utilisation aOR 2.09, 95 % CI 1.48–2.94, p < 0.005). | Greater programme exposure associated with increased collective identity, collective efficacy and collective agency (no exposure vs active utilisation p < 0.001 in bivariate analysis for all items). | |
Lippman et al. [67] | Encontros Corumba, Brazil | Cohort Analytic Baseline and follow-up at 3, 6, 9 and 12 months later. | Sex workers: female, male and transvestite. N = 420 | Baseline and 4 follow-ups. Ever exposed vs unexposed | Individual and interpersonal level: increased health services provision, counselling, free condoms provision, peer education and outreach. Community level: forging of community partnerships, collective activities (e.g. workshops), mobilisation for dialogue, formation of a sex workers association, distribution of destigmatising materials. | No differences in probability of incident STI for exposed participants compared with unexposed (aOR 0.46, 95 % CI 0.2–1.3). | Exposure related to higher likelihood of reporting consistent condom use with regular clients (aOR 1.9, 95 % CI 1.1–3.3, p < 0.05), with no differences with new clients (aOR 1.6, 95 % CI 0.9–2.8) and non-paying partners (aOR 1.5, 95 % CI 0.9–1.5). | Active participants increased participation in networks (SD 0.3, 95 % CI 0.1–0.5) and did not change perceived cohesion (SD 0.1, 95 % CI −0.1 to 0.24). |
Gutierrez et al. [63] | Frontiers Prevention Project Andhra Pradesh, India | Cohort analytic Baseline and follow-up 4 years later. | FSW & MSM in 12 geographically distinct sites N = 2786MSM (1680 FPP, 1106 non-FPP); 3442 FSW (1692 FPP, 1750 non-FPP). | Baseline and follow-up. Non-FPP (12 sites) receiving Avahan intervention | STI services, behaviour change communication, condom programmes, community mobilisation, and enabling and structural interventions. Emphasis on social capital building, network and support formation, empowerment, violence reduction, referrals for HIV testing and basic AIDS care services. | Intervention correlated with lower probability of sero-positivity to HSV-2 and syphilis among both MSM (p < 0.001, p < 0.05) and FSW (p < 0.05, p < 0.001). | MSM: intervention related to increase in condom use with last female sexual partner (p < 0.05) but no difference with last male sexual partner. FSW: intervention associated with increase in condom use with regular partners (p < 0.05) but no difference with last sexual client. | NA |
Gutierrez et al. [69] | Frontiers Prevention Project Ecuador | Cohort analytic Baseline and follow-up 4 years later. | FSW & MSM in 6 cities N = 1727 MSM (1248 FPP, 479 non-FPP); 1526 FSW (752 FPP, 774 non-FPP) | Baseline and follow-up. 3 intervention cities vs 3 comparison cities with standard national HIV initiatives | Individually focused health promotion. Ensuring access, scaling-up targeting and improving service and commodity delivery. Mobilisation of key populations’ communities (participatory assessment, leadership workshops, human rights promotion, establishing of solid networks, safe meeting spaces provision). Advocacy, policy change and community awareness. Capacity building of NGOs and CBOs to effectively implement quality prevention interventions. | MSM: No difference in seroprevalence of HIV (aOR 0.84, 95 % CI 0.31 − 2.31) and HSV-2 (aOR 0.40, 95 % CI 0.11–1.5). Reduced odds of syphilis seroprevalence (aOR 0.32, 95 % CI 0.14–0.72). FSW: No difference in seroprevalence of HIV (aRR 0.75, 95 % CI 0.42–1.3) and syphilis (aRR 1.08, 95 % CI 0.70–1.67). Lower risk of HSV2 seroprevalence (aRR 0.93, 95 % CI 0.85–0.99). | MSM: Higher odds of condom use with a male partner associated with intervention (aOR 2.89, 95 % CI 1.34–6.28). No difference in condom use with female partners (aOR 1.91, 95 % CI 0.47–7.8). FSW: No difference in condom use with clients (aRR 0.98, 95 % CI 0.93–1.00) and regular partners (aRR 1.29, 95 % CI 0.85–1.90) associated with intervention. | NA |
Kerrigan et al. [70] | Sonagachi-inspired 3 sites in Rio de Janeiro, Brazil | Cohort 18 months | FSW older than 18 years N = 499 | Pre-post intervention | Current FSW peer educator as agents of social change, trained to bring about and discuss issues of common concern. FSW organisation. Drop-in centre as safe space to discuss and hold project workshops and activities. Community identified priority action areas that received funding and technical assistance. | NA | No difference in consistent condom use with all clients in the last 4 months (87.2–88.6 %, p = 0.287) and consistent condom use with all (paying and non-paying) partners in last week (80.40–79.0 %, p = 0.808). | Social participation increased from 0.74 to 1.23 (p < 0.0001). No differences in sense of community as social cohesion and mutual aid (values not reported). |
Williams et al. [71] | Carletonville project. Mothusimpilo intervention. Carletonville, South Africa. | Cohort 2 years. | Miners and sex workers, general population. Miners = 899 Sex workers = 121 Men = 443 Women = 691 | Baseline and follow-up | Community-based peer education, condom distribution, syndromic management of STIs and presumptive STI treatment for sex workers. | Increases in prevalence of: Syphilis: among miners (5.5–8.3 %, aOR 1.57, p = 0.02) and women (9.8–18.7 %, aOR 2.06, p < 0.01). Gonorrhoea: miners (3.0–7.4 %, aOR 2.61, p = 0.01). Chlamydial infection: miners (3.8–13.9 %, aOR 4.23, p < 0.01), men (3.6–12.4 %, aOR 3.54, p < 0.01) and women (7.9–13.8 %, aOR 1.88, p < 0.01). No differences in STI were computed for sex workers in syphilis (25.0– 34.4 %, aOR 1.56, p = 0.15)., gonorrhoea (15.7–16.1 %, aOR 1.01, p = 0.96) and chlamydial infection (9.1–12.9 %, aOR 1.45, p = 0.40). | “Ever used a condom” report increased among miners (39.5–51.3 %, aOR 1.66, p < 0.01) and women (33.1–42.3 %, aOR 1.58, p < 0.01), but not among men (48.1–54.8 %, aOR 1.23, p = 0.17). “Always use condoms with casual partner” report increased among miners (13.2–27.2 %, aOR 2.45, p < 0.01) men (14.7–35.6 %, aOR 3.19, p < 0.01) and women (17.8–24.9 %, aOR 1.56, p = 0.03). No significant differences were reported among sex workers for “ever used a condom” (69.7–77.2 %, aOR 1.39, p = 0.34) and “always use condoms with casual partner” (54.3–41.9 %, aOR 0.57, p = 0.07). | NA |
Schensul et al. [39] | RISHTA 3 communities of Mumbai, India | Cohort 3 years | Married men aged 21–40 yrs. N = 2408 | Pre-post intervention. Longitudinal panel sample (n = 403) | Formative community mapping. Community education: street dramas, community meetings, poster sessions, banner presentations, videos/movies, printed materials, interpersonal communication. | NA | Change in extramarital sex related to change in alcohol use (p < 0.01). Men who were drinkers in BL but non-drinkers in EL and non-drinkers more likely to report reduction in extramarital sex compared to their drinkers counterparts. | NA |
Benzaken et al. [68] | Princesinha Project in Manacapuru, Amazonas State, Brazil | Cohort 2 years | FSW N = 148 | Baseline and follow-up | Sex workers peer-education and referrals to services. Activities on a daily and weekly basis. Activities to increase project visibility and to foster sex workers’ social inclusion. Peer educators conducted mapping of condom retail locations and data collection about the town’s sex work networks and dynamics. | NA | Increases in reported condom use for oral sex with clients (37.2– 56.1 %, p < 0.001), in all situations (0.0–77.7 %, p < 0.001) and during last week (41.9–78.0 %, p < 0.001). Non-significant increases in reported condom use in anal sex with clients (37.2–48.2 %, p = 0.050) and in vaginal sex with clients 68.9–77.7 %, p = 0.090). | NA |
Guha et al. [59] | Avahan States of Tamil Nadu and Maharashtra, India | Case control 18 months | FSW N = 9111 | Comparison between (Avahan and non-Avahan) intervention exposure: either active or passive. Distinction between metropolitan and ‘rest of state’ areas. Propensity score matching including matched controls unexposed to intervention | Trainings and meetings of FSWs, formation of self-help groups. Facilitating formation of CBOs. Fostering of capacity building and power negotiation. | NA | Increases in consistent condom use with all clients associated with level of participation: Attending a training session: Rest of Tamil Nadu (p < 0.001) and rest of Maharashtra (p = 0.008). Belonging to a self-help group: Rest of Tamil Nadu (p < 0.001) and Mumbai (p < 0.001). Belonging to a FSW collective: Mumbai (p = 0.013). No significant effects for Chennai. | Except in Mumbai, joining meeting or training associated with collective efficacy and community support. Belonging to a self-help group associated with collective efficacy in the rest of Tamil Nadu and Mumbai. Belonging to a self-help group associated with community support in the rest of Tamil Nadu and rest of Maharashtra |
Ng et al. [60] | Avahan Six Indian states: Nagaland, Manipur, Tamil Nadu, Maharashtra, Karnataka and Andhra Pradesh. | Case control 2003–2008 | High-risk groups (FSW, their clients and partners, MSM, IDU, and truck drivers). N = 626,232(?) | Comparison between intensity of Avahan by district (amount of grant per HIV population) using National Family Health Survey | Peer outreach for safe –sex counselling. Clinical services. Distribution of free condoms. Needle and syringe exchange. Community mobilisation and advocacy activities. | Greater programme intensity associated with lower likelihood of HIV prevalence in Andhra Pradesh (effect size −0.0026, 95 % CI −0.0044 to −0.0009, p = 0.004), Karnataka (effect size −0.0026, 95 % CI −0.0042 to −0.0008, p = 0.004) and Maharashtra (effect size −0.0022, 95 % CI −0.0039 to −0.0005, p = 0.008). Non-significant association in the other 3 states. | NA | NA |
Ramesh et al. [61] | Avahan Five districts within Karnataka state: Mysore, Belgaum, Shimoga, Bellary and Bangalore Urban | Cohort Baseline: 7–19 months after project initiation; follow-up: 28–37 months later. | FSW N = 2312 | Baseline and follow-up | Participatory mapping and enumeration exercises. Peer-mediated outreach and behaviour change communication. Dedicated sexual health services with STI syndromic management. Advocacy with stakeholders. Creation of drop-in centres (safe spaces for dialogue and services). Community mobilisation and capacity building. | Reductions prevalence of HIV (aOR 0.81, 95 % CI 0.67–0.99, p = 0.04), high-titre syphilis (aOR 0.53, 95 % CI 0.37–0.77, p = 0.001) and chlamydia and/or gonorrhoea (aOR 0.72, 95 % CI 0.54–0.94, p = 0.02). No differences in syphilis (aOR 0.77, 95 % CI 0.57–1.04, p = 0.09). | Increases in condom use at last sex with repeat clients (aOR 1.98, 95 % CI 1.58–2.48, p < 0.001). No differences in condom use at last sex with occasional clients (aOR 1.22, 95 % CI 0.89–1.66, p = 0.2) and regular partners (aOR 1.07, 95 % CI 0.76–1.51, p = 0.7). | NA |
Reza-Paul et al. [62] | Avahan Mysore district only | Cohort Baseline: 6 months after project initiation, follow-up 2.5 years later | FSW N = 429 | Baseline and follow-up | Participatory mapping and enumeration exercise. Community mobilisation and peer-mediated outreach. Increased access to sexual health services, expansion of condom availability in non-traditional outlets. Creating an enabling environment to support the programme. | No difference in HIV prevalence (aOR 0.91, 95 % CI 0.66–1.23) Increases in HSV-2 prevalence (64.4–79.0 %, aOR 2.15, 95 % CI 1.46–3.18, p < 0.001) Decreases in STI prevalence: syphilis (aOR 0.38, 95 % CI 0.25–0.59, p < 0.001); trichomonas (aOR 0.28, 95 % CI 0.18–0.41, p < 0.001); chlamydial infection (aOR 0.52, 95 % CI 0.27–0.96, p = 0.04) and gonorrhoea (aOR 0.42, 95 % CI 0.17–1.01, p = 0.03). | Increases in condom use: at last sex with occasional clients (aOR 4.30, 95 % CI 2.80–6.62, p < 0.001); with repeat clients (aOR 1.76, 95 % CI 1.22–2.55, p = 0.003); with regular partners (aOR 5.49, 95 % CI 2.91–10.37, p < 0.001). “Zero unprotected sex acts in past months” increased (aOR 5.45, 95 % CI 3.82–7.79, p < 0.001) | NA |
Saggurti et al. [57] | Avahan Andhra Pradesh, India | Case control 2003–2010 | FSW and men who have sex with men and transgenders (HR-MSM) FSW = 3,557 HR-MSM = 2,399 | Comparison between low and high degree of 4 CM indicators: collective efficacy (both groups), collective agency (only FSW), collective action (only FSW), and participation in public events (only HR-MSM) | “[T]he implementation of community mobilization varied, with the differences mainly in group structures and focus on the local priorities and needs of communities”. | NA | FSW: High collective efficacy associated with greater likelihood of consistent condom use (CCU) with occasional (aOR 1.3, 95 % CI 1.1–1.7) and regular (aOR 1.4, 95 % CI 1.1–1.9) clients, and with STI treatment at government health facilities in past year (aOR 3.3, 95 % CI 2.1–5.1) High collective agency associated with greater likelihood of STI treatment only (aOR 1.6, 95 % CI 1.1–2.2) Collective action associated with greater likelihood of CCU with occasional (aOR 1.3, 95 % CI 1.1–1.8) and regular (aOR 1.5, 95 % CI 1.1–2.0) clients, and with a lower likelihood of STI treatment (aOR 0.5, 95 % CI 0.3–0.8). HR-MSM: participation in public event associated with greater likelihood of CCU with paid (aOR 3.3, 95 % CI 2.1–5.2) and paying (aOR 2.7, 95 % CI 2.0–3.6) partners. Higher collective efficacy associated with greater likelihood of CCU with paying partners. (aOR 1.9, 95 % CI 1.5–2.3) only. | NA |
Blanchard et al. [58] | Avahan Districts in Karnataka (Belgaum, Gulbarga, Gadag, Dharwad) and Maharashtra (Solapur), India | Case control | FSW N = 1,750 | Comparison between high intensity intervention (Belgaum, Gulbarga and Gadag) and low intensity intervention (Dharwad and Solapur) districts. Analysis by dimensions of empowerment (within, with and over) Only power with (collective identity and solidarity) included here | CM through an “integrated empowerment framework”: sex work organisation, program and structural interventions, sociodemographic characteristics impacting upon empowerment dimensions, which in turn result into the power to address a disempowering social context (power imbalances, social exclusion and vulnerability). Sensitisation of stakeholders in and beyond the community. | NA | In both high and low intensity districts, power with was associated with likelihood of condom use at last sex with regular client (aOR 2.56, p < 0.001; aOR 1.65, p < 0.01) and frequency of condom use with regular clients (aOR 2.27, p < 0.001; aOR 1.80, p < 0.001), with no significant differences in condom use at last sex with regular partner, frequency of condom use with regular partner and number of visits to health clinic for health problems. | Power with was associated with lower odds of violence or abuse by more powerful groups in high intensity districts (aOR 1.34, p < 0.05), but not in low intensity ones. |
Parimi et al. [64] | India HIV/AIDS Alliance programme Andhra Pradesh, India | Case control 2004–2010 | FSW in 5 districts of Andhra Pradesh N = 1,986; n = 1116 from project areas where STI services were in partnership with government | 870 FSW (43.8 % of sample) from project areas where STI services were delivered by other (agency-implemented or in partnership with private providers) STI service delivery models | Promotion of governmental STI services utilisation. Syndromic management of STIs among government facilities. Sensitisation meetings with outreach staff and community members. Community-based group promotion of health care facilities use among FSW. Awareness camps focused on risk perception: games, street plays, puppet shows and magnet theatre shows. | NA | Regardless of project area, FSW who reported high collectivisation (collective-efficacy, -agency and -action) were more likely to access STI treatment from government health facilities in the previous year than their low collectivisation counterparts (78.1 vs 63.2 %, aOR 2.1, 95 % CI 1.6–2.8) | NA |
STUDY | Assigned designa
| Selection bias | Study design | Confounders | Blinding | Data collection method | Withdrawals and dropouts | Global rating |
---|---|---|---|---|---|---|---|---|
Doyle et al. [50] | RCT | Strong | Strong | Strong | Moderate | Strong | Moderate | Strong |
Kamali et al. [54] | RCT | Strong | Strong | Strong | Moderate | Strong | Moderate | Strong |
Cowan et al. [49] | RCT | Moderate | Strong | Strong | Moderate | Strong | Weak | Moderate |
Gregson et al. [52] | RCT | Moderate | Strong | Strong | Moderate | Strong | Weak | Moderate |
Jewkes et al. [51] | RCT | Weak | Strong | Strong | Moderate | Strong | Moderate | Moderate |
Pronyk et al. [53] | RCT | Moderate | Strong | Strong | Moderate | Strong | Weak | Moderate |
Sweat et al. [15] | RCT | Moderate | Strong | Weak | Weak | Strong | Moderate | Weak |
Kerrigan et al. [14] | Cohort analytic | Moderate | Moderate | Strong | Moderate | Strong | Moderate | Strong |
Gao and Wang [72] | Cohort analytic | Moderate | Moderate | Strong | Moderate | Weak | Strong | Moderate |
Swendeman et al. [65] | Cohort analytic | Strong | Moderate | Strong | Moderate | Weak | Moderate | Moderate |
Erausquin et al. [56] | Cohort analytic | Moderate | Moderate | Moderate | Moderate | Weak | Strong | Moderate |
Lippman et al. [67] | Cohort analytic | Moderate | Moderate | Strong | Moderate | Strong | Weak | Moderate |
Gutierrez et al. [63] | Cohort analytic | Weak | Moderate | Strong | Weak | Strong | Weak | Weak |
Gutiérrez et al. [69] | Cohort analytic | Weak | Moderate | Strong | Weak | Strong | Weak | Weak |
Kerrigan et al. [70] | Cohort | Moderate | Moderate | Strong | Moderate | Weak | Strong | Moderate |
Williams et al. [71] | Cohort | Weak | Moderate | Moderate | Moderate | Strong | Moderate | Moderate |
Schensul et al. [39] | Cohort | Moderate | Moderate | Moderate | Moderate | Weak | Strong | Moderate |
Benzaken et al. [68] | Cohort | Weak | Moderate | Moderate | Moderate | Weak | Weak | Weak |
Ng et al.b [60] | Case control | Moderate | Moderate | Strong | Moderate | Strong | Moderate | Strong |
Parimi et al. [64] | Case control | Moderate | Moderate | Strong | Moderate | Weak | Moderate | Moderate |