HIV prevention in Tanzania: the role of types of sexual partnerships, early sexual histories and community factors

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health

Abstract

Nature of proposed research
HIV prevention among young people is an urgent priority. Research has shown that prevention interventions such as sex education in schools can increase knowledge about HIV and sexual and reproductive health. However, such interventions have not been able to reduce the number of young people infected with HIV and other sexually transmitted infections (STI). There is a gap between knowledge of how to avoid HIV and other sexual risks among young people and actual behaviour change. We need to find effective ways to prevent HIV among young people in sub-Saharan Africa.

This research will use data collected during a recent survey of over 13,000 young people in rural Tanzania. Young people told us who they have sex with and described the type of relationship with each of their recent sexual partners. We can make a map to see if young people infected with HIV live in certain areas eg near to a major road or town. Analysing this information will help us to understand where and when a young person is most likely to take risks. The results of this research will be used to design interventions that will help young people to reduce their risk of being infected.

Technical Summary

Background
Young people are particularly vulnerable to HIV and other sexually transmitted infections (STI). Preventing HIV amongst young people is vital if the spread of the epidemic is to be halted. Since January 1999, in rural Tanzania, the MEMA kwa Vijana package of adolescent Sexual and Reproductive Health (SRH) interventions (teacher-led, in-school SRH education; youth-friendly health services; community activities; youth condom promotion and distribution) have been implemented in 10 randomly chosen intervention communities, with 10 similar communities acting as a comparison group. From May 2007 to July 2008, 13,814 youth aged 17-27 years from these 20 communities were surveyed. Results showed that SRH knowledge had been improved and retained, but that this intervention had little effect on reported behaviours and none on HIV/STI prevalence. These results suggest that an urgent rethink is needed to prevent HIV infection among young people. Integrating future youth interventions within intensive, community-wide programmes to reduce their risk and vulnerability may be more successful.
Aim:
To investigate factors associated with the prevalence of HIV/STI among youth in rural Tanzania in order to improve HIV prevention intervention design and evaluation.
Objectives:
(1) Investigate the association between sexual partner types and prevalence of STI and higher risk practices (2) Conduct spatial mapping of HIV/STI and determine whether cases are associated with proximity to health services, trading centres, roads and other geographical factors (3) Explore the relationship between exposures in early adolescence and later sexual risk behaviours (4) To investigate methodological issues (characteristics of those lost to follow-up, consistency in reporting of sexual behaviour) (5) Develop recommendations for future interventions to improve the SRH of young people.
Methods:
Secondary analysis of MEMA kwa Vijana Community Randomised Trial data. Individual demographic and SRH data including HIV/STI infection status are available for a cohort of over 9,500 youth (1998 to 2001/02) and in 2007/08 for a cross-sectional survey of over 13,500 youth. These data are of particular value due to the uniquely long length of follow-up and the biological outcome data. Detailed data on the last 3 sexual partners and GPS data, collected in 2007/08, will allow description of sexual partnerships and geographical mapping of sexual risk.
Opportunities:
The results of these new analyses, in combination with MEMA kwa Vijana trial results, its associated qualitative research and results of other intervention trials will be examined and recommendations made on potential future interventions in terms of content, target groups and evaluation design.

Publications

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Title MkV data archive 
Description Through this research grant we were able to document the MEMA kwa Vijana (MkV) data in DDI2 format. This involved collating and creating dataset descriptions and metadata for the MkV datasets from the 1998, 2000, 2001/2 and 2007/8 surveys. The data are now in a format which is suitable for archiving and which should allow researchers outside of our group to understand the data without needing to contact the investigators. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact These are the first dataset that has been archived in this way at Mwanza Intervention Trials Unit (MITU). We hope that other studies working at MITU will also document their data in this way. 
 
Description INDEPTH Health Transitions to Adulthood Study (IHTAS) 
Organisation Dodowa Health Research Centre
Country Ghana 
Sector Hospitals 
PI Contribution I am a named researcher on the grant providing technical support for the design, conduct and reporting of the research activities.
Collaborator Contribution Partner organisations are responsible for the conduct of of the research in Ghana and Kenya.
Impact Quantitative and qualitative interviews have taken place and the data are currently being analysed and scientific articles are being drafted. The expected outcome of this preliminary work will be a proposal for a trial to evaluation an adolescent health intervention. This collaboration is multi-disciplinary and involves social scientists, epidemiologists, statisticians and data managers.
Start Year 2013
 
Description INDEPTH Health Transitions to Adulthood Study (IHTAS) 
Organisation International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH)
Country Ghana 
Sector Charity/Non Profit 
PI Contribution I am a named researcher on the grant providing technical support for the design, conduct and reporting of the research activities.
Collaborator Contribution Partner organisations are responsible for the conduct of of the research in Ghana and Kenya.
Impact Quantitative and qualitative interviews have taken place and the data are currently being analysed and scientific articles are being drafted. The expected outcome of this preliminary work will be a proposal for a trial to evaluation an adolescent health intervention. This collaboration is multi-disciplinary and involves social scientists, epidemiologists, statisticians and data managers.
Start Year 2013
 
Description INDEPTH Health Transitions to Adulthood Study (IHTAS) 
Organisation Wellcome Trust
Department KEMRI-Wellcome Trust Research Programme
Country Kenya 
Sector Academic/University 
PI Contribution I am a named researcher on the grant providing technical support for the design, conduct and reporting of the research activities.
Collaborator Contribution Partner organisations are responsible for the conduct of of the research in Ghana and Kenya.
Impact Quantitative and qualitative interviews have taken place and the data are currently being analysed and scientific articles are being drafted. The expected outcome of this preliminary work will be a proposal for a trial to evaluation an adolescent health intervention. This collaboration is multi-disciplinary and involves social scientists, epidemiologists, statisticians and data managers.
Start Year 2013