Abstract:
NAMWEZA 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.
Methods A 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, selfefficacy,
self-esteem, HIV risk behaviour and IPV.
Results For 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).
Conclusion These 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.
