NIMH Project Accept

HIV testing and support in Sub-Saharan African and Thailand

At a glance:

Project Name:  

NIMH Project Accept

Brief overview

Project Accept is a Phase III randomized controlled trial of community mobilization, mobile testing, same-day results, and post-test support for HIV in in sub-Saharan Africa and Thailand. Thirty-four communities in Africa (South Africa, Tanzania, and Zimbabwe) and 14 communities in Thailand are randomized to receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT), or SVCT alone. The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention.

 

Geographical location:  

Soweto and Vulindlela, South Africa; Kisarawe, Tanzania; Chiang Mai, Thailand; Mutoko, Zimbabwe

 

Target population:  

Men and women residing in study communities, particularly those aged 16-32.

 

Intervention model:

Tipping point theory; diffusion of innovation theory; social action theory

 

Research Methods:  

  • Community Engagement
  • Baseline Behavioral Assessment
  • Community Matching
  • Qualitative Assessment
    • Community Mapping and Ethnography
    • In-Depth Interviews
  • CBVCT Communities
    • Community Mobilization
    • Easy Access to VCT
    • Post-Test Support Services
    • Quality Assurance
  • Control Communities
    • Clinic-Based VCT
    • Quality Assurance
  • Post-Intervention Assessment
    • Post-Intervention Biological Assessment
    • Post-Intervention Behavioral Assessment
  • Cost-Effectiveness Analysis

 

Local significance (How has this project impacted the immediate population?):

The Project Accept intervention has the following impact in study communities:

  • Making VCT more available in community settings
  • Engaging the community through outreach
  • Providing post-test support

 

If it is successful, Project Accept will have the following impact on study communities:

  • Reduced incidence of HIV infection
  • Less HIV risk behavior
  • Higher rates of HIV testing
  • More favorable social norms regarding HIV testing
  • More frequent discussions about HIV
  • More frequent disclosure of HIV status
  • Less HIV-related stigma
  • Fewer HIV-related negative life events

 

International significance (How has this project impacted the global community?):

From the perspective of national AIDS control planners in hard-hit countries, evidence-based strategies that have maximum epidemic impact are critically needed. These planners need interventions that are sustainable and can be adapted to the context of their local cultures. This is the first randomized controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence endpoint in the developing world. Provided that we can document efficacy with regard to HIV incidence and incremental cost-effectiveness, we expect that resources for widespread implementation of community-based VCT will become available from USAID or the Global Fund. We have worked closely with representatives of national AIDS programs in the host countries to ensure that the intervention is sustainable even in countries with limited resources.