Feasibility of conducting HIV combination prevention interventions in fishing communities in Uganda: A pilot cluster randomised trial

• Published in: PloS one 2019-03, Vol.14 (3), p.e0210719-e0210719
• Main Authors: Kuteesa, Monica O, Weiss, Helen A, Abaasa, Andrew, Nash, Stephen, Nsubuga, Rebecca N, Newton, Rob, Seeley, Janet, Kamali, Anatoli
• Format: Article
• Language: English
• Subjects: Accounting; Acquired immune deficiency syndrome; Adult; AIDS; Antiretroviral agents; Biology and Life Sciences; Circumcision; Circumcision, Male - statistics & numerical data; Clinical trials; Clusters; Communities; Community; Community participation; Condoms; Demographic aspects; Disease prevention; Drug therapy; Education; Epidemiology; Feasibility Studies; Female; Fishers (Persons); Fishing; Fishing (Recreation); Fishing communities; Health Behavior; Health facilities; Health Promotion - methods; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Hygiene; Incidence; Infections; Intervention; Lost to Follow-Up; Male; Medical diagnosis; Medicine; Medicine and health sciences; People and Places; Pilot Projects; Polls & surveys; Population; Prevention; Randomization; Research and Analysis Methods; Rural areas; Rural Health; Social Sciences; Substance abuse treatment; Systematic review; Tetanus; Uganda - epidemiology; Urban areas; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210719

We assessed feasibility of an HIV-combination-prevention trial among fishing communities in Uganda. Cluster randomised trial in four fishing communities on Lake Victoria, Uganda. Two intervention communities received a combination-prevention-package (behaviour change communication, condom promotion, HIV testing, voluntary male medical circumcision and referral for anti-retroviral therapy if HIV-positive). All four communities received routine government HIV care services. Using household census data we randomly selected a cohort of consenting residents aged ≥18 years. A baseline sero-survey in July 2014 was followed by two repeat surveys in March and December 2015. We measured uptake of HIV prevention methods, loss-to-follow-up and HIV incidence, accounting for multistage survey design. A total of 862 participants were enrolled and followed for 15 months. Participation was 62% and 74% in the control and intervention arms respectively; Overall loss to follow up (LTFU) was 21.6% and was similar by arm. Self-reported abstinence/faithfulness increased between baseline and endline in both arms from 53% to 73% in the control arm, and 55% to 67% in the intervention arm. Reported condom use throughout the study period was 36% in the intervention arm vs 28% in the control arm; number of male participants reporting circumsicion in both arms from 58% to 79% in the intervention arm, and 39% to 46% in the control arm. Independent baseline predictors of loss-to-follow-up were: being HIV positive, residence in the community for 1 month/year. Recruitment and retention of participants in longitudinal trials in highly mobile HIV fishing communities is challenging. Future research should investigate modes for locating and retaining participants, and delivery of HIV-combination prevention.