Abstract #265  -  Integrating biomedical and behavioral interventions into a practical approach to HIV prevention
Authors:   Presenting Author:   Dr. Danuta Kasprzyk - Battelle - University of Washington
Additional Authors:  Dr. Daniel Montaņo,
Aim: This presentation illustrates how a combined prevention intervention was implemented during a randomized control community-based trial of the Popular Opinion Leader (POL) Model intervention in 30 rural sites around Zimbabwe. In both arms of the study, a behavioral risk assessment, HIV counseling and testing, and STD testing and treatment were conducted. The intervention arm was supplemented by POL training with selected community popular leaders.
Method / Issue: Many community-based interventions use behavior change motivational or educational approaches, without incorporating biomedical elements, such as diagnosis and treatment of STDs. STD clinics may not do a thorough job of risk reduction counseling, or may not use other behavior change strategies. As part of a 5-country international HIV/STD prevention trial, we implemented the POL intervention in 30 rural sites in Zimbabwe and evaluated its impact. Target group individuals, about equal numbers of males and females, were recruited from social venues. Baseline, 12-month, and 24-month data were collected from a cohort of 5543 people aged 18-30. A combined approach in all sites included behavioral and biomedical components. We assessed behavioral risks including sexual history and behavior, demographics, alcohol use, and STD symptoms. Sexual behavior data, including frequency, relationship type, and condom use were collected with up to 5 recent partners. Biological samples were collected and tested at a central laboratory for HIV, HSV2, Gonorrhea, Chlamydia, Syphilis, Trichamonaisis, and Bacterial Vaginosis. The symptom assessment included pre-test counseling and post-test counseling and STD treatment was provided to those individuals who returned for lab-diagnosed results. The POL intervention was implemented after Baseline data collection in half (15) the sites.
Results / Comments: Cohort analyses showed a reduction across the 24-months in various risk behaviors. Analyses on two endpoints (one behavioral, one biological) showed that the experimental and comparison group sites both had a 33% reduction in unprotected sex acts with non-spousal partners, and a similar reduction in the combined biological outcome of incident HIV/STDs. Other risky behaviors, alcohol use (both frequency of alcohol use and frequency of drunk days) also declined by 20% across both intervention and comparison groups.
Discussion: This study showed that in both arms of the trial with a combined prevention approach using behavioral and biomedical strategies was equally successful in reducing risk of HIV or STD acquisition and increasing condom use with non-spousal partners. Public health interventions using behavioral risk assessment, and including pre-test counseling and HIV testing, and diagnosis and treatment of STDs are a good example of the integration of biomedical and behavioral approaches. The fact that both arms in the trail showed an equal reduction in behavioral risk and STD/HIV acquisition, illustrates the value of a combined biomedical and behavioral approach. We also showed that an approach combining behavioral and biomedical interventions can be implemented with success in community-based settings, expanding the possibility of using biomedical approaches outside of clinics. This STD/HIV prevention trial serves as an excellent example of how a combined behavioral and biomedical approach can reduce STD and HIV incidence, as well as risky sexual behavior.
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