Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe. Evaluation of a cognitive-behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women. Impact of peer education on HIV infection in Zimbabwe. Evaluation of a prevention intervention to reduce HIV Risk among Angolan soldiers. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel. An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India. A randomized controlled trial to evaluate the relative efficacy of adding voluntary counseling and testing (VCT) to information dissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers.
HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT).
                The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).
                High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT. Few cognitive-behavioral interventions have focused on preventing sexually transmitted infections (STIs) and unintended pregnancies (UPs) in young, sexually active women in a single study. Military recruit training provides a well-defined, national, nonclinic sample in which to evaluate such an intervention.
                All female Marine recruits (N=2,288) in training were approached. Of these, 2,157 (94.3%) voluntarily agreed and were randomly assigned, by platoons, to participate in cognitive-behavioral interventions to prevent STIs or UPs or to prevent physical training injuries and cancer. Participants completed self-administered questionnaires and were screened for pregnancy, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline and, on average, 1 and 14 months postintervention.
                A higher proportion of the control group had a postintervention STI or UP [odds ratio (OR)=1.41, 95% confidence interval (CI)=1.01-1.98]. Among participants who had no history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was more likely to acquire a postintervention STI (OR=3.24, CI=1.74-6.03). Among participants who were not sexually experienced at baseline, the control group was more likely to have casual (OR=2.05, 95% CI=1.04-4.08) and multiple (OR=1.87, 95% CI=1.01-3.47) sexual partners postintervention.
                This randomized controlled trial indicates that cognitive-behavioral interventions are effective for reducing behavioral risk and preventing STIs and UPs in young, sexually active women who are not seeking health care. nan We developed and evaluated a military-focused HIV prevention intervention to enhance HIV risk-reduction knowledge, motivation, and behaviors among Angolan soldiers. Twelve bases were randomly assigned to HIV prevention or control conditions, yielding 568 participants. HIV prevention participants received training in preventing HIV (4.5 days) and malaria (0.5 days). Control participants received the reverse. Monthly booster sessions were available after each intervention. We assessed participants at baseline, 3 and 6 months after the training. HIV prevention participants reported greater condom use and less unprotected anal sex at 3 months, as well as greater HIV-related knowledge and perceived vulnerability at 3 and 6 months. Within-group analyses showed HIV prevention participants increased condom use, reduced unprotected vaginal sex, and reduced numbers of partners at both follow-ups, while control participants improved on some outcomes at 3 months only. A military-focused HIV prevention intervention may increase HIV-related knowledge, motivation, and risk reduction among African soldiers. Anecdotal evidence suggests that the HIV/AIDS prevalence rates in several African armed forces are high, with gender inequality rendering female military personnel more vulnerable to the disease. The objective of this study was to replicate a successful videotape-based HIV prevention intervention among Nigerian female military personnel in an effort to establish the cross-cultural stability, feasibility and cost-effectiveness of this approach in resource-limited countries. Enlisted women (N346) were recruited from two cantonments in Southwestern Nigeria and randomly assigned to either (a) a 5-session video-based, small group, cognitive-behavioral, HIV prevention intervention, or (b) a 5-session, video-based, contact-matched, HIV education control condition. Participants provided self-report of their HIV/AIDS-related knowledge and sexual behaviors at baseline, 3 and 6 months after completing the intervention. The results indicate that the motivational skills-building intervention did not improve participants' knowledge of HIV/AIDS any better than did the HIV education control condition at each assessment period, but it significantly increased condom use among women in this group by 53.6% at 3-month follow-up. HIV preventive behaviors among women in the motivational skills-building intervention group improved significantly, being 2 and 3 times more, compared to women in the HIV education control group at 3-month and 6-month follow-up assessments. The intervention also significantly improved behavioral intentions of participants as well as reduced alcohol use before sex by 25%, after 3 months; and number of sexual partners by 12% after 6 months. Women in the intervention group were five times more likely than women in HIV education control group to suggest that their new male partners use condom. These findings indicate that a videotape-based, HIV prevention intervention is a feasible and effective approach to HIV prevention among female military personnel from sub-Saharan Africa.
                Copyright © 2010 Elsevier Ltd. All rights reserved. The incidence of HIV/AIDS in India is increasing drastically, and truck drivers are seen as critical sources of HIV transmission due to their high rates of unprotected sex with multiple partners. An intervention based on the Information-Motivation-Behavioral Skills (IMB) model was compared to an information-only control condition in a randomized trial. IMB constructs were assessed among 250 male truck drivers immediately prior to and following implementation of the intervention, and sexual and condom use behaviors were assessed approximately 10 months later. The intervention consisted of a single-session group workshop with 5 interactive activities designed to address HIV prevention-related IMB constructs and to motivate condom use. Findings showed mixed support for the effectiveness of the intervention. There was an effect of the IMB intervention on attitudes, norms, behavioral skills, and intentions specific to condom use with marital partners, but no effects on constructs related to non-marital partners. There was some evidence of greater condom use with marital and non-marital partners at behavioral follow-up for participants in the IMB condition, and effects on condom use with marital partners were mediated by changes in IMB constructs. These findings provide initial evidence for the effectiveness of theoretically-based approaches to HIV prevention in India. Mobile populations are vulnerable to contracting HIV. The present study aims to evaluate the relative efficacy of the voluntary counseling and testing plus information dissemination (VCT-ID) approach versus the information dissemination (ID) approach for promoting HIV preventive behaviors in a mobile population, cross-border truck drivers. A total of 301 adult male cross-border truck drivers who self-reported having had sex with female sex workers (FSW) or non-regular sex partners (NRPs) in mainland China in the last 12 months were recruited and randomized into the VCT-ID intervention group (Group I) or ID control group (Group C). Anonymous structured questionnaires, administered through a computer-assisted method, were used to collect data. At the follow-up survey (about 8-9 weeks since the baseline survey), Group I participants, as compared to Group C participants, were more likely to be consistent condom users when having sex with FSW (85.5% versus 68.5%, p<0.05) and with NRP (54.8% versus 36.4%, p<0.1), more knowledgeable about HIV, and were less likely to have contracted sexually transmitted diseases (STD) in the last two months. The VCT-ID approach is shown to be more efficacious than the ID approach in promoting safer sex and HIV-related knowledge among local cross-border truck drivers. Feasibility of providing voluntary counseling and testing (VCT) services at locations which are convenient to the target population is demonstrated. It also shows that VCT services can be used as a means of HIV prevention. The findings of this study resulted in up-scaled VCT services for the local target population.
Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.
More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.