{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:11:02Z","timestamp":1788473462494,"version":"build-2803163510"},"reference-count":51,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["U01AI150510"],"award-info":[{"award-number":["U01AI150510"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["U01AI150510"],"award-info":[{"award-number":["U01AI150510"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Optimizing HIV prevention may require structured approaches for providing client\u2010centred choices as well as community\u2010based entry points and delivery. We evaluated the effect of a dynamic choice model for HIV prevention, delivered by community health workers (CHWs) with clinician support, on the use of biomedical prevention among persons at risk of HIV in rural East Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cluster randomized trial among persons (\u226515 years) with current or anticipated HIV risk in 16 villages in Uganda and Kenya (SEARCH; NCT04810650). The intervention was a client\u2010centred HIV prevention model, including (1) structured client choice of product (pre\u2010exposure prophylaxis [PrEP] or post\u2010exposure prophylaxis [PEP]), service location (clinic or out\u2010of\u2010clinic) and HIV testing modality (self\u2010test or rapid test), with the ability to switch over time; (2) a structured assessment of patient barriers and development of a personalized support plan; and (3) phone access to a clinician 24\/7. The intervention was delivered by CHWs and supported by clinicians who oversaw PrEP and PEP initiation and monitoring. Participants in control villages were referred to local health facilities for HIV prevention services, delivered by Ministry of Health staff. The primary outcome was biomedical prevention coverage: a proportion of 48\u2010week follow\u2010up with self\u2010reported PrEP or PEP use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From May to July 2021, we enrolled 429 people (212 intervention; 217 control): 57% women and 35% aged 15\u201324 years. Among intervention participants, 58% chose PrEP and 58% chose PEP at least once over follow\u2010up; self\u2010testing increased from 52% (baseline) to 71% (week 48); \u226598% chose out\u2010of\u2010facility service delivery. Among 413 (96%) participants with the primary outcome ascertained, average biomedical prevention coverage was 28.0% in the intervention versus 0.5% in the control: a difference of 27.5% (95% CI: 23.0\u201331.9%, <jats:italic>p<\/jats:italic>&lt;0.001). Impact was larger during periods of self\u2010reported HIV risk: 36.6% coverage in intervention versus 0.9% in control, a difference of 35.7% (95% CI: 27.5\u201343.9, <jats:italic>p<\/jats:italic>&lt;0.001). Intervention effects were seen across subgroups defined by sex, age group and alcohol use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A client\u2010centred dynamic choice HIV prevention intervention, including the option to switch between products and CHW\u2010based delivery in the community, increased biomedical prevention coverage by 27.5%. However, substantial person\u2010time at risk of HIV remained uncovered.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26195","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T17:45:22Z","timestamp":1701884722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["A community\u2010based dynamic choice model for HIV prevention improves PrEP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9532-5710","authenticated-orcid":false,"given":"Elijah R.","family":"Kakande","sequence":"first","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0324-4006","authenticated-orcid":false,"given":"James","family":"Ayieko","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Sunday","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Biira","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Nyabuti","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Agengo","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Kabami","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"},{"name":"Department of Medicine Makerere University College of Health Sciences  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colette","family":"Aoko","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hellen N.","family":"Atuhaire","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norton","family":"Sang","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asiphas","family":"Owaranganise","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Litunya","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick W.","family":"Mugoma","sequence":"additional","affiliation":[{"name":"Global Programs for Research &amp; Training  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5860-8081","authenticated-orcid":false,"given":"Gabriel","family":"Chamie","sequence":"additional","affiliation":[{"name":"Division of HIV Infectious Diseases, and Global Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Schrom","sequence":"additional","affiliation":[{"name":"Division of HIV Infectious Diseases, and Global Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie C.","family":"Bacon","sequence":"additional","affiliation":[{"name":"Department of Health and Human Services National Institute of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration  Kampala Uganda"},{"name":"Department of Medicine Makerere University College of Health Sciences  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-3136","authenticated-orcid":false,"given":"Diane V.","family":"Havlir","sequence":"additional","affiliation":[{"name":"Division of HIV Infectious Diseases, and Global Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya L.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Division of Biostatistics University of California Berkeley  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Balzer","sequence":"additional","affiliation":[{"name":"Division of Biostatistics University of California Berkeley  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the SEARCH Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,6]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711203372101"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5011"},{"key":"e_1_2_12_5_1","unstructured":"World Health Organization.Guidelines on post\u2010exposure prophylaxis for HIV and the use of co\u2010trimoxazole prophylaxis for HIV\u2010related infections among adults adolescents and children: recommendations for a public health approach.2014[cited 2023 Jan 26]. Available from:http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/145719\/9789241508193_eng.pdf?sequence=1."},{"key":"e_1_2_12_6_1","unstructured":"(UNAIDS) JUNPoHA.In Danger: UNAIDS Global AIDS Update 2022.https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2022\u2010global\u2010aids\u2010update_en.pdf;2022[cited 2023 Jan 26]."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25942"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237427"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-02780-x"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03360-3"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2021.637869"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40271-020-00486-9"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.2989\/16085906.2019.1686032"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02418-7"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224566"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-017-1851-1"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2017.1367086"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X17729376"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000768"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-015-0074-7"},{"key":"e_1_2_12_21_1","unstructured":"World Health Organization.What do we know about community health workers? A systematic review of existing reviews.2020."},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153051"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0134767"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25670"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30433-3"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/10901981740020S106"},{"key":"e_1_2_12_27_1","volume-title":"Health program planning. An educational and ecological approach","author":"Green LW","year":"2005"},{"key":"e_1_2_12_28_1","volume-title":"Cluster randomised trials","author":"Hayes RJ","year":"2017"},{"key":"e_1_2_12_29_1","doi-asserted-by":"crossref","unstructured":"BalzerLB KakandeER AyiekoJ KabamiJ ChamieG KamyaMR et\u00a0al.Statistical analysis plan for dynamic HIV choice prevention delivered with community health workers in phase A of SEARCH\u2010Sapphire. medRxiv;2023;https:\/\/doi.org\/10.1101\/2023.11.15.23298580medRxiv","DOI":"10.1101\/2023.11.15.23298580"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7023"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxab043"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-735"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7122-5"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03451-1"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.16.1.18586"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1537-0"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0040902"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-12-194"},{"issue":"7","key":"e_1_2_12_39_1","article-title":"Task shifting from doctors to non\u2010doctors for initiation and maintenance of antiretroviral therapy","volume":"1","author":"Kredo T","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czs058"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.04.020411"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-9-27"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.07.010"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001741"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-017-4398-1"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.14-0094"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1177\/09564624221121208"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-286"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1080\/17441690903334232"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-9-22"},{"issue":"10","key":"e_1_2_12_51_1","article-title":"Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: a qualitative evidence synthesis","volume":"2013","author":"Glenton C","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czu126"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26195","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T05:26:22Z","timestamp":1704950782000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":51,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1002\/jia2.26195"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26195","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]},"assertion":[{"value":"2023-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26195"}}