HIV & Drug Abuse Prevention for South African Men

NCT ID: NCT02358226

Last Updated: 2020-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

1211 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-05-31

Study Completion Date

2020-01-31

Brief Summary

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The purpose of this study is to test the efficacy of randomizing all young men in a neighborhood to receive: 1) soccer training; 2) soccer and vocational training; or 3) a control condition, as a means to engage young men in HIV prevention. The investigators hypothesize that the intervention will reduce young men's substance use and increase HIV testing.

Detailed Description

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South Africa has the highest number of HIV-infected persons of any nation, including 2.4 million men, and from 2002-2011 young men have had a 3% incidence HIV rate that has remained stable. New infections occur later in men than in women, making men in their 20s a target for intervention. Decreasing sexual risk and concurrent partnerships is a key outcome in interventions to reduce HIV incidence. Most men (68%) report unprotected sex, typically with three partners in the last three months,and more than half of young men do not use condoms with casual partners.

In South Africa, the amount of alcohol consumed per adult is among the highest in the world. 'Heavy episodic drinking', which most strongly correlates with risky sexual behaviors and HIV infection, is reported by 60% of men. Alcohol, tik (methamphetamine) and marijuana are common among young men in South Africa. Among alcohol abusers, men are highly likely to be poly substance users. Among HIV seropositive young men, drug use is common. Drug and alcohol use is associated with risky sexual behaviors and an increase in the number of sexual partners.

In townships, alcohol is involved in or responsible for 60% of automobile accidents, 75% of homicides, 50% of non-natural deaths, 67% of domestic violence, 30% of hospital admissions, and costs South Africa about R9 billion annually. Violence also characterizes the lives of young men in the Xhosa townships. Intimate partner violence is frequent in alcohol-using partnerships and is correlated with increased HIV incidence. Substance use and unemployment often lead to violence in a township. Jobs, by contrast, provide income and create a strong and respected community role.

HIV prevention efforts for young people in Sub-Saharan Africa have largely been unsuccessful: novel, structural, community level programs that address the social determinants of HIV are needed. Unemployment and a culture of alcohol and violence are major social determinants of HIV among young men. Yet, men are often excluded from economic development programs. Young, South African men need new pathways for prosocial roles and behaviors and our interventions need to be attractive and consistent with men's styles. The social determinants of HIV (unemployment, alcohol, and violence) are critical to creating opportunities for prosocial roles for young men. One of the most common comments by both the men and their families in our previous pilot qualitative study on soccer and vocational training was men's lack of "things to do." Given these needs, the investigators focus on soccer and vocational training in this randomized controlled trial as opportunities for young men to acquire the habits of daily living that are most likely to result in jobs, health, and positive relationships.

Conditions

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Substance-Related Disorders Human Immunodeficiency Virus Alcoholism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Soccer League (SL)

In the SL arm, participants will be invited to participate in a Soccer League, led by coaches who meet the criteria of: 1) soccer skills, 2) being a role model, and 3) social competence. Coaches will undergo intensive training in ethics; role-playing the delivery of health messages; conducting brief interventions for alcohol; how to acquire information on HIV, TB, alcohol use and employment; linkages to local clinics, data collection; and Street Smart, an evidence-based intervention for high-risk youth. Coaches will provide pre- and post-game talks, incorporating the topics of alcohol and drugs; interacting positively with health care providers, partners and family members; HIV, diabetes; daily routines; healthy social networks; making and saving money; loyalty and national success.

Group Type EXPERIMENTAL

Soccer League (SL)

Intervention Type BEHAVIORAL

Participants will be invited to attend soccer practice in the late afternoons, roughly 2-3 times per week. Competitive games will be held on Saturdays so that friends and family may attend. Using a mobile phone application, coaches will regularly record information on participants' arrival and departure times, sportsmanship, volunteering in the community, the results of saliva tests for drugs and alcohol. The SL intervention arm will last for one year.

Soccer League/Vocational Training (SL-V)

The SL-V arm will include both the SL intervention as well as access to Vocational Training through either Silulo Ulutho Technologies, which offers computer courses, or Zenzele Training and Development programs, which provides training in woodwork and wielding. Both programs are located in Khayelitsha, which is close to participants' homes, thus avoiding transport-related barriers. Additionally, the training programs occur in a mentor-mentee context so that participants can develop the interpersonal skills required for employment.

Group Type EXPERIMENTAL

Soccer League/Vocational Training (SL-V)

Intervention Type BEHAVIORAL

In addition to the SL intervention, participants will gain access to vocational training. The Vocational Training will take place through the Silulo or Zenzele programs based in Khayelitsha for a period of 6 months. These programs offer practical and market-related training in computer skills, woodwork, or welding. The SL-V intervention arm will last for one year; with six months dedicated to soccer and six months dedicated to vocational training.

Control Condition (CC)

Participants in the CC arm will routinely receive flyers with picture stories regarding HIV prevention strategies and how to access these strategies: HIV testing, circumcision, HIV treatment, including ARV, condoms and sexually transmitted diseases.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Soccer League (SL)

Participants will be invited to attend soccer practice in the late afternoons, roughly 2-3 times per week. Competitive games will be held on Saturdays so that friends and family may attend. Using a mobile phone application, coaches will regularly record information on participants' arrival and departure times, sportsmanship, volunteering in the community, the results of saliva tests for drugs and alcohol. The SL intervention arm will last for one year.

Intervention Type BEHAVIORAL

Soccer League/Vocational Training (SL-V)

In addition to the SL intervention, participants will gain access to vocational training. The Vocational Training will take place through the Silulo or Zenzele programs based in Khayelitsha for a period of 6 months. These programs offer practical and market-related training in computer skills, woodwork, or welding. The SL-V intervention arm will last for one year; with six months dedicated to soccer and six months dedicated to vocational training.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* not employed
* sleeps at least 4 nights per week in the two months prior to recruitment in a household in the target neighborhood boundaries
* speaks Xhosa or English
* provides voluntary informed consent and understands the consent process
* does not appear to be actively hallucinating or incapable of understanding the interviewer

Exclusion Criteria

* if the interviewer reports that the young man demonstrates delusional talk or cannot comprehend the voluntary informed consent forms
Minimum Eligible Age

18 Years

Maximum Eligible Age

29 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Mary Jane Rotheram-Borus

Director, Global Center for Children and Families

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mary Jane Rotheram, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry & Biobehavioral Sciences, Semel Institute, UCLA

Locations

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Stellenbosch University

Stellenbosch, , South Africa

Site Status

Countries

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South Africa

References

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UNAIDS, WHO, & UNICEF. (2011). Global HIV/AIDS response: epidemic update and health sector progress towards universal access (progress report 2011). Geneva, Switzerland: UNAIDS, WHO, & UNICEF.

Reference Type BACKGROUND

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Statistics South Africa. (2013). Quarterly Labour Force Survey: Quarter 2, 2013. Cape Town, South Africa: Statistics South Africa.

Reference Type BACKGROUND

Aral SO, Peterman TA. Measuring outcomes of behavioural interventions for STD/HIV prevention. Int J STD AIDS. 1996;7 Suppl 2:30-8. doi: 10.1258/0956462961917753. No abstract available.

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Epstein, H. (2007). The invisible cure: Africa, the West, and the fight against AIDS. New York, NY: Farrar, Straus, and Giroux.

Reference Type BACKGROUND

Bhana, D., & Pattman, R. (2009). Researching South African youth, gender and sexuality within the context of HIV/AIDS. Development, 52(1), 68-74.

Reference Type BACKGROUND

Reddy, S. P., Panday, S., Swart, D., Jinabhai, C. C., Amosun, S. L., James, S., Monyeki, K. D., Stevens, G., Morejele, N., Kambaran, N. S., Omardien, R. G., & Van den Borne, H.W. (2003). Umthenthe Uhlaba Usamila - The South African Youth Risk Behaviour Survey 2002. Cape Town, South Africa: South African Medical Research Council.

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South African Department of Health, Medical Research Council. (2007). South Africa Demographic and Health Survey 2003. Pretoria, South Africa: Department of Health.

Reference Type BACKGROUND

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Scott-Sheldon LA, Carey MP, Carey KB, Cain D, Harel O, Mehlomakulu V, Mwaba K, Simbayi LC, Kalichman SC. Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town, South Africa. Addict Behav. 2012 Apr;37(4):492-7. doi: 10.1016/j.addbeh.2012.01.002. Epub 2012 Jan 11.

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Morojele NK, Kachieng'a MA, Mokoko E, Nkoko MA, Parry CD, Nkowane AM, Moshia KM, Saxena S. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Soc Sci Med. 2006 Jan;62(1):217-27. doi: 10.1016/j.socscimed.2005.05.031. Epub 2005 Jul 27.

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PMID: 18264762 (View on PubMed)

Parry, C. D. H., & Bennetts, A. L. (1998). Alcohol policy and public health in South Africa. Cape Town: Oxford University Press.

Reference Type BACKGROUND

Simbayi, L. C., Kalichman, S. C., Cain, D., Cherry, C., Henda, N., & Cloete, A. (2006). Methamphetamine use and sexual risks for HIV infection in Cape Town, South Africa. Journal of Substance Use, 11(4), 291-300.

Reference Type BACKGROUND

MRC Crime, Violence and Injury Lead Programme. (2003). A Profile of Fatal Injuries in South Africa. Fourth Annual Report of the National Injury Mortality Surveillance System. Pretoria: MRC.

Reference Type BACKGROUND

Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002 Apr 20;359(9315):1423-9. doi: 10.1016/S0140-6736(02)08357-5.

Reference Type BACKGROUND
PMID: 11978358 (View on PubMed)

Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010 Jul 3;376(9734):41-8. doi: 10.1016/S0140-6736(10)60548-X.

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PMID: 20557928 (View on PubMed)

Michielsen K, Chersich MF, Luchters S, De Koker P, Van Rossem R, Temmerman M. Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials. AIDS. 2010 May 15;24(8):1193-202. doi: 10.1097/QAD.0b013e3283384791.

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UNAIDS. (2010). UNAIDS 2010 Report on the Global AIDS Epidemic. Retrieved from: http://www.unaids.org/globalreport/Global_report.htm

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Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008 Aug 30;372(9640):764-75. doi: 10.1016/S0140-6736(08)60887-9. Epub 2008 Aug 5.

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PMID: 18687460 (View on PubMed)

Dean HD, Fenton KA. Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis. Public Health Rep. 2010 Jul-Aug;125 Suppl 4(Suppl 4):1-5. doi: 10.1177/00333549101250S401. No abstract available.

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PMID: 20629250 (View on PubMed)

Harwood JM, Weiss RE, Comulada WS. Beyond the Primary Endpoint Paradigm: A Test of Intervention Effect in HIV Behavioral Intervention Trials with Numerous Correlated Outcomes. Prev Sci. 2017 Jul;18(5):526-533. doi: 10.1007/s11121-017-0788-y.

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Rotheram-Borus MJ, Tomlinson M, Stewart J, Skiti Z, Rabie S, Wang J, Almirol E, Vogel L, Christodoulou J, Weiss RE. Soccer and Vocational Training are Ineffective Delivery Strategies to Prevent HIV and Substance Abuse by Young, South African Men: A Cluster Randomized Controlled Trial. AIDS Behav. 2024 Dec;28(12):3929-3943. doi: 10.1007/s10461-024-04458-0. Epub 2024 Sep 11.

Reference Type DERIVED
PMID: 39259241 (View on PubMed)

Rabie S, Tomlinson M, Almirol E, Stewart J, Skiti Z, Weiss RE, Vogel L, Rotheram-Borus MJ. Utilizing Soccer for Delivery of HIV and Substance Use Prevention for Young South African Men: 6-Month Outcomes of a Cluster Randomized Controlled Trial. AIDS Behav. 2023 Mar;27(3):842-854. doi: 10.1007/s10461-022-03819-x. Epub 2022 Nov 15.

Reference Type DERIVED
PMID: 36380117 (View on PubMed)

Rabie S, Bantjes J, Gordon S, Almirol E, Stewart J, Tomlinson M, Rotheram-Borus MJ. Who can we reach and who can we keep? Predictors of intervention engagement and adherence in a cluster randomized controlled trial in South Africa. BMC Public Health. 2020 Feb 27;20(1):275. doi: 10.1186/s12889-020-8357-x.

Reference Type DERIVED
PMID: 32106835 (View on PubMed)

Christodoulou J, Stokes LR, Bantjes J, Tomlinson M, Stewart J, Rabie S, Gordon S, Mayekiso A, Rotheram-Borus MJ. Community context and individual factors associated with arrests among young men in a South African township. PLoS One. 2019 Jan 17;14(1):e0209073. doi: 10.1371/journal.pone.0209073. eCollection 2019.

Reference Type DERIVED
PMID: 30653530 (View on PubMed)

Rotheram-Borus MJ, Tomlinson M, Mayekiso A, Bantjes J, Harris DM, Stewart J, Weiss RE. Gender-specific HIV and substance abuse prevention strategies for South African men: study protocol for a randomized controlled trial. Trials. 2018 Aug 3;19(1):417. doi: 10.1186/s13063-018-2804-3.

Reference Type DERIVED
PMID: 30075740 (View on PubMed)

Other Identifiers

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1R01DA038675-01A1

Identifier Type: NIH

Identifier Source: secondary_id

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R01DA038675

Identifier Type: NIH

Identifier Source: org_study_id

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