Village community mobilization is associated with reducedHIVincidence in young South African women participating in theHPTN068 study cohort

Abstract

IntroductionAdolescent girls and young women (AGYW) in South Africa bear a disproportionate burden of HIV. Community mobilization (CM), defined as community members taking collective action to achieve a common goal related to health, equity and rights, has been associated with increased HIV testing and condom use and has been called a ‘critical enabler’ for addressing the HIV epidemic. However, limited research has examined whether CM is associated with HIV incidence among AGYW.MethodsWe examine the association of CM with incident HIV among AGYW (ages 13 to 21) enrolled in the HPTN 068 cohort in the Agincourt Health and socio‐Demographic Surveillance System, South Africa. This analysis includes 2292 participants residing in 26 villages where cross‐sectional, population‐based surveys were conducted to measure CM among 18‐ to 35‐year‐old residents in 2012 and 2014. HPTN 068 participants completed up to five annual visits that included an HIV test (2011 to 2016). Household‐level data were collected from AGYW parents/guardians and census data is updated annually. Mean village‐level CM scores were created using a validated community mobilization measure with seven components (social cohesion, social control, critical consciousness, shared concerns, organizations and networks, leadership and collective action). We used pooled generalized estimating equation regression with a Poisson distribution to estimate risk ratios (RR) for the association of village‐level CM score and CM components with incident HIV infection, accounting for village‐level clustering and adjusting for key covariates.ResultsThere were 194 incident infections over the follow‐up period. For every additional standard deviation of village‐level CM there was 12% lower HIV incidence (RR: 0.88, 95% CI: 0.79, 0.98) after adjusting for individual, household and community characteristics. CM components associated with lower HIV incidence included critical consciousness (RR: 0.88; CI: 0.79, 0.97) and leadership (RR: 0.87; CI: 0.79, 0.95); while not statistically significant, social cohesion (RR: 0.91; CI: 0.81, 1.01), shared concerns (RR: 0.90; CI: 0.81, 1.00), and organizations and networks (RR: 0.91; CI: 0.79, 1.03) may also play a protective role.ConclusionsThese results suggest that having strong community social resources will reduce AGYW's risk of HIV acquisition. Work to mobilize communities, focusing on building social cohesion, shared concerns, critical consciousness, and effective and accountable leadership, can fortify prevention programming for AGYW.

It is not just about “the trial”: the critical role of effective engagement and participatory practices for moving the HIV research field forward

“…Lippman and colleagues carry this theme further in their description of theory‐based community mobilization to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub‐Saharan Africa, where engagement and participatory practice were the intervention rather than merely the means for facilitating interventional research . Their study is the first to show that community mobilization is associated with lower HIV incidence among AGYW.…”

Reaching at-risk women for PrEP delivery: What can we learn from clinical trials in sub-Saharan Africa?

“…As countries move from clinical trials and demonstration projects to real-world oral PrEP delivery, it will be essential to engage communities to promote acceptance and minimize stigmatization of PrEP [29]. Given the impetus on trials to adhere to the Good Participatory Practice (GPP) Guidelines, it is not surprising that trials employed extensive community engagement strategies [30, 31]. A recent systematic review describes a range of techniques to engage communities in clinical trials [30].…”

Fostering gender equality and alternatives to violence: perspectives on a gender-transformative community mobilisation programme in rural South Africa

“…We conducted a cluster randomised control trial to evaluate the impact of One Man Can, a gender-transformative community mobilisation programme that challenges gender norms condoning or facilitating violence and sexual risk behaviour and raises consciousness around the intersection of gender norms and HIV (Pettifor et al 2015;Pettifor et al 2018;Lippman et al 2018). The programme was implemented from April 2012 to June 2014 in 11 of 22 villages in the Agincourt Health and Socio-Demographic Surveillance System study area, about 500 kilometres northeast of Johannesburg; the remaining 11 villages were control villages.…”

“…As documented in Table 1, over 33% of 18-35-year-old men in intervention communities participated in at least one two-day workshop, and over 5,800 community mobilisation activities were implemented by the end of Year 2 (Pettifor et al 2018). Some 66% of men and 40% of women had medium to high exposure to the programme, and community social cohesion and critical consciousness increased for people exposed to the programme (Pettifor et al 2018;Lippman et al 2018). Between baseline and endline, there were statistically significant improvements in men's, but not women's, gender-equitable attitudes.…”