Evidence map›Paper›PMID 25103167›Full record

Trial reportThe Lancet. Global health2014

Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial.

Thomas J Coates, Michal Kulich, David D Celentano, Carla E Zelaya, Suwat Chariyalertsak, Alfred Chingono, Glenda Gray, Jessie K K Mbwambo, Stephen F Morin, Linda Richter and 10 more

2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Global health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 107 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
107citing papers in PubMed, 12 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00203749 phase3completednot on this map

NIMH Project Accept: A Phase III Randomized Controlled Trial of Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand

TypeinterventionalSponsorUniversity of California, Los AngelesRan2004 to 2011Enrolled192,814ConditionsHIV InfectionsArmsCommunity-Based HIV VCT, Standard clinic-based VCT
NCT07064928 naenrolling by invitationnot on this mapstarted 2024, after this paper: background citation

We Are Together (WAT): Development and Testing of an Intervention to Reduce HIV Related Stigma Among Pregnant and Postpartum Women

TypeinterventionalSponsorUniversity of California, San FranciscoRan2024 to 2027Enrolled175ConditionsHIV, HIV - Human Immunodeficiency Virus, Postpartum, PregnancyArmsAdapted Project Accept's Post-Test Support Services (PTSS) Module 3
3 · Its place in the literature

Who cites it

107 citing papers in PubMed, 12 syntheses or guidelines pooled it.

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47 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors.

Thomas J CoatesUniversity of California, Los Angeles, UCLA Center for World Health, Los Angeles, CA, USA. Electronic address: tcoates@mednet.ucla.edu.
Michal KulichCharles University, Faculty of Mathematics and Physics, Prague, Czech Republic.
David D CelentanoJohns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
Carla E ZelayaJohns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
Suwat ChariyalertsakChiang Mai University, Research Institute for Health Sciences, Chiang Mai, Thailand.
Alfred ChingonoUniversity of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
Glenda GrayUniversity of the Witwatersrand, Chris Hani Baragwanath Hospital, Faculty of Health Sciences, Perinatal HIV Research Unit, Soweto, South Africa.
Jessie K K MbwamboMuhimbili University of Health and Allied Sciences, Muhimbili University Teaching Hospital, Dar es Salaam, Tanzania.
Stephen F MorinUniversity of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
Linda RichterHuman Sciences Research Council, Dalbridge, South Africa.
Michael SweatMedical University of South Carolina, Family Services Research Center, Charleston, SC, USA.
Heidi van RooyenHuman Sciences Research Council, Durban, South Africa.
Nuala McGrathUniversity of Southampton, Southampton General Hospital, Southampton, UK.
Agnès FiammaUniversity of California, Los Angeles, UCLA Center for World Health, Los Angeles, CA, USA.
Oliver LaeyendeckerJohns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA; The National Institutes of Health, Bethesda, MD, USA.
Estelle Piwowar-ManningDepartment of Pathology, Baltimore, MD, USA.
Greg SzekeresUniversity of California, Los Angeles, UCLA Center for World Health, Los Angeles, CA, USA.
Deborah DonnellFred Hutchinson Cancer Research Center, Seattle, WA, USA.
Susan H EshlemanDepartment of Pathology, Baltimore, MD, USA.
NIMH Project Accept (HPTN 043) study team

Funding

LOC: HIV Prevention Trials NetworkUM1AI068619 · NIAID · FAMILY HEALTH INTERNATIONAL · PI MYRON Scott COHEN, Sinead Delany-Moretlwe · 2011 to 2026
$779.5M
SDMC: HPTN 084 Pregnancy SupplementUM1AI068617 · NIAID · FRED HUTCHINSON CANCER RESEARCH CENTER · PI Elizabeth Renata Brown, Deborah J Donnell · 2011 to 2026
$204.9M
LC: HIV Prevention Trials Network - Laboratory Support for the SARS-CoV-2 Seroprevalence Study (CoVPN 5002)UM1AI068613 · NIAID · JOHNS HOPKINS UNIVERSITY · PI SUSAN H ESHLEMAN, Mark A Marzinke · 2011 to 2026
$100.2M
HIV Prevention trials Network (HPTN) Coordinating and Operations CenterU01AI068619 · NIAID · FAMILY HEALTH INTERNATIONAL · PI VERMUND, STEN H. · 2006 to 2010
$72.7M
UCLA Clinical and Translational Science InstituteUL1TR000124 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$57.0M
UCLA Rapid, Relevant, Rigorous Implementation Science HubP30MH058107 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI RAPHAEL J LANDOVITZ · 1997 to 2026
$53.5M
Virology CoreP30AI028697 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ANTON, PETER A · 1991 to 2018
$39.9M
Leadership for HIV/AIDS Clinical Trials Networks; HIV Prevention Trials NetworkU01AI068617 · NIAID · FRED HUTCHINSON CANCER RESEARCH CENTER · PI DONNELL, DEBORAH J · 2006 to 2010
$28.8M
Community-Based HIV VCT: South AfricaU01MH066701 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI COATES, THOMAS J. · 2003 to 2010
$24.3M
HIV Prevention Trials Network: Network LaboratoryU01AI068613 · NIAID · JOHNS HOPKINS UNIVERSITY · PI ESHLEMAN, SUSAN H · 2006 to 2010
$16.5M
International Studies of the Acquired Immune Deficiency Syndrome (AIDS)ZIAAI000361 · NIAID · NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES · PI REDD, ANDREW · 2009 to 2025
$15.8M
Community-Based VCT: ZimbabweU01MH066702 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MORIN, STEPHEN F · 2003 to 2010
$13.4M
NCATS NIH HHS UL1 TR000124NIAID NIH HHS P30 AI028697NIAID NIH HHS U01 AI068613NIAID NIH HHS U01AI068613NIAID NIH HHS U01 AI068617NIAID NIH HHS U01AI068617NIAID NIH HHS U01 AI068619NIAID NIH HHS U01AI068619NIAID NIH HHS UM1 AI068613NIAID NIH HHS UM1AI068613NIAID NIH HHS UM1 AI068617NIAID NIH HHS UM1AI068617NIAID NIH HHS UM1 AI068619NIAID NIH HHS UM1AI068619NIMH NIH HHS P30 MH058107NIMH NIH HHS U01 MH066687NIMH NIH HHS U01MH066687NIMH NIH HHS U01 MH066688NIMH NIH HHS U01MH066688NIMH NIH HHS U01 MH066701NIMH NIH HHS U01MH066701NIMH NIH HHS U01 MH066702NIMH NIH HHS U01MH066702Wellcome Trust 097410
6 · The paper itself

Abstract

backgroundAlthough several interventions have shown reduced HIV incidence in clinical trials, the community-level effect of effective interventions on the epidemic when scaled up is unknown. We investigated whether a multicomponent, multilevel social and behavioural prevention strategy could reduce HIV incidence, increase HIV testing, reduce HIV risk behaviour, and change social and behavioural norms.

methodsFor this phase 3 cluster-randomised controlled trial, 34 communities in four sites in Africa and 14 communities in Thailand were randomly allocated in matched pairs to receive 36 months of community-based voluntary counselling and testing for HIV (intervention group) or standard counselling and testing alone (control group) between January, 2001, and December, 2011. The intervention was designed to make testing more accessible in communities, engage communities through outreach, and provide support services after testing. Randomisation was done by a computer-generated code and was not masked. Data were collected at baseline (n=14 567) and after intervention (n=56.683) by cross-sectional random surveys of community residents aged 18-32 years. The primary outcome was HIV incidence and was estimated with a cross-sectional multi-assay algorithm and antiretroviral drug screening assay. Thailand was excluded from incidence analyses because of low HIV prevalence. This trial is registered at ClinicalTrials.gov, number NCT00203749.

findingsThe estimated incidence of HIV in the intervention group was 1.52% versus 1.81% in the control group with an estimated reduction in HIV incidence of 13.9% (relative risk [RR] 0.86, 95% CI 0.73-1.02; p=0.082). HIV incidence was significantly reduced in women older than 24 years (RR=0.70, 0.54-0.90; p=0.0085), but not in other age or sex subgroups. Community-based voluntary counselling and testing increased testing rates by 25% overall (12-39; p=0.0003), by 45% (25-69; p<0·0001) in men and 15% (3-28; p=0.013) in women. No overall effect on sexual risk behaviour was recorded. Social norms regarding HIV testing were improved by 6% (95% CI 3-9) in communities in the intervention group.

interpretationThese results are sufficiently robust, especially when taking into consideration the combined results of modest reductions in HIV incidence combined with increases in HIV testing and reductions in HIV risk behaviour, to recommend the Project Accept approach as an integral part of all interventions (including treatment as prevention) to reduce HIV transmission at the community level.

fundingUS National Institute of Mental Health, the Division of AIDS of the US National Institute of Allergy and Infectious Diseases, and the Office of AIDS Research of the US National Institutes of Health.

Indexed as

Community NetworksCounselingPatient Acceptance of Health CareRisk Reduction BehaviorAdolescentAdultAfricaFemaleHealth BehaviorHIV InfectionsHumansIncidenceMaleOutcome Assessment, Health CareThailandYoung Adult

Identifiers

PMID25103167
PMCPMC4131207

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.