) The Rakai Health Sciences Program (RHSP), Uganda, proposes an implementation science community- randomized controlled trial (CRCT) of a novel intervention to newly in-migrated individuals (?Welcome In- coming Neighbor? [WIN]), to optimize their rapid linkage to combination HIV prevention (CHP) services. RHSP data show that within the first 36 months after in-migration, compared to residents, HIV-negative in-migrants are at increased risk of HIV acquisition and HIV+ in-migrants underutilize antiretroviral therapy (ART) increasing the risk of onward transmission. The theory-based WIN intervention includes community sensitization, community-based WIN scouts (WINs), and enhanced, differentiated clinic services for in- migrants. WINs will conduct active community surveillance to rapidly identify and welcome in-migrants, provide them with information about the availability of CHP and high rates of use by residents (to ?normalize? uptake), utilize a motivational interviewing approach to encourage CHP adoption, refer in-migrants to free services, provide vouchers enabling them to receive priority clinic services, and follow-up in-migrants to assess and further encourage engagement in CHP.
Specific Aims :
Aim 1 : To randomize 40 individually matched communities in a 1:1 ratio to the WIN intervention or control arm. In-migrants aged 15-49 in each arm will undergo a baseline and 2 follow-up surveys at ~18-month intervals. Primary end points are HIV incidence in initially HIV-negative in-migrants (n ~3,800 py per arm), and viral load suppression in HIV+ (n ~740 per arm). CHP coverage rates and sexual behaviors will also be compared (secondary outcomes).
Aim 2 a: To use a mixed methods approach (in-depth interviews, process & survey data) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to (i) guide interim intervention adaptation as necessary; (ii) interpret trial results; and, (iii) translate the research into future action.
Aim 2 b: To conduct cost studies to provide information on affordability and sustainability. Innovation and Impact: This novel intervention will rapidly engage a vulnerable priority population of in-migrants, to optimize CHP and HIV impact in rural Uganda.
Migration is common in rural Africa: in-migrants have higher HIV incidence and prevalence than community residents, but underutilize antiretroviral therapy, potentially leading to onward HIV transmission. Uptake of combined HIV prevention (CHP) is critical in this vulnerable population. We will conduct a community randomized trial to rapidly identify and link migrants to CHP in rural Uganda; if effective, the intervention could be widely implemented as an important strategy towards HIV epidemic control.
