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Table 2 Characteristics of 13 studies of HIV interventions among factory workers in LMICs

From: Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review

  First author Published year Study design Region Length of follow-up Intervention type
  Kuchaisit C 1996 RCT Thailand 12 months Education
Sample size (before/after) Intervention group: 153 workers/133 workers; Control group: 148 workers/127 workers
Intervention 1. Health workers organized a 20-min presentation of HIV every two weeks, using slides, brochures, and two-way presentations.
2. Communication regarding AIDS, correct use of condoms, and posters exhibition.
Outcome 1. Contact with extra-partner in the past 12 months (intervention group from 16 to 5%, P = 0.021).
2. Unprotected sex in the past 12 months (slight decrease, 3% in control, 6% in education group, P < 0.05).
3. Knowledge of HIV were found significantly higher in the education group compared to the control group (P < 0.05).
  Sakondhavat C 1998 Cohort Thailand 12 months Education
Sample size (before/after) 305 workers /288 workers
Intervention 1. Health workers provided cartoons, posters, radios, television, lectures and brochures about HIV/AIDS.
2. Over the past 12 months, three in-depth interviews were conducted with workers to understand changes in their HIV knowledge, attitudes and high-risk behavior.
Outcome 1. In the past 12 months, the proportion of workers who drank alcohol before sex decreased from 17 to 6.3% (P < 0.01) and took recreational drugs decreased from 2.6 to 0.7% (P < 0.01).
2. The proportion of workers who did not use condoms during extramarital or premarital sex in the last 12 months decreased from 6.9 to 3.8% (P < 0.01)
3. HIV/AIDS prevention and transmission knowledge improved (P < 0.05).
4. HIV negative attitude decreased from 46.6 to 30.6% (P < 0.001).
  Bassett M 1998 RCT Zimbabwe 6 months Combination of peer education and community intervention
Sample size (before/after) Intervention group: 20 factories (2219 workers /1731 workers)
Control group: 20 factories (NR)
Intervention 1. Providing HCT services and Sexually Transmitted Disease (STD) treatment.
2. One peer educator trained 100 workers, maintained a continuous supply of free condoms at worksites, and organized at least one drama and two presentations by persons living with HIV/AIDS, including one man and one woman.
3. Peer educators led discussions, showed videos and slide shows.
Outcome HIV infection rates in the intervention group were 40% lower than in the control group (1.51 vs. 2.52 per 100 persons-years, P < 0.05).
  Machekano R 1998 Cohort Zimbabwe 28 months Community intervention
Sample size (before/after) 2414 workers /2060 workers
Intervention Provide HCT (during recruitment and follow-up period), including individual risk assessment, discussion of HIV risk factors and modes of transmission, the meaning of test results and preventing HIV, and availability of treatment and support.
Outcome 1. Workers at high risk behaviors were more likely to go to HCT, and proactive provision of HCT could increase the detection rate of HIV (relative risk (RR): 1.87, 95% confidence interval (CI): 1.01 to 3.61) and STD (RR: 3.47, 95%CI: 2.51 to 4.89).
2. After 28 months, among men who went to HCT, a non-significant 40% decrease in HIV seroconversion (4.82 vs. 3.04 per 100 person-years, P = 0.18) and 30% increase in STDs incidence (10.84 vs. 14.79 per 100 person-years, P = 0.11) was observed compared to before.
3. In the second follow-up, HIV seroconversion was higher among subjects who obtained their test results at the first follow-up compared to those who did not (19.5% vs. 16.7%, respectively, P = 0.01)
  Qian X 2007 Cohort China 6 months Education
Sample size (before/after) Intervention group: 340 workers /258 workers
Control group: 257 workers /168 workers
Intervention 1. Health workers disseminated knowledge and information about contraceptive and condom use to factory workers.
2. Lectures given by experts, content about STD prevention.
3. Distributing free condoms and contraceptives and providing HIV/STD counselling service.
Outcome 1. Contraception use has increased from 70 to 93% in the past three months (P < 0.05).
2. Condom use has increased from 41 to 70% in the past three months (P < 0.05).
  Zhu C 2014 Cohort China 9 months Combination of education and community intervention
Sample size (before/after) Intervention group: (2980 workers /1425 workers)
Control group: (1060 workers /2139 workers)
Intervention 1. Health workers provided sexual health education (Knowledge about healthy sexual activities; STD and HIV/AIDS knowledge, effects, prevention, symptoms; appropriate ways to obtain health care for STD, HIV/AIDS).
2. Providing HCT services and promoting mental and physical health, such as mental health, reasonable diet and exercise. Disease and injury prevention, such as influenza or workplace injury prevention.
Outcome 1. The rate of change of the intervention group who gave correct answers to the HIV/AIDS knowledge was significantly higher than that of control group (3.5% vs 1.1%, P < 0.05).
2. In the intervention group, the proportion of workers who knew where provided free educational counselling was improved (3.5 to 6.7%, P < 0.001).
3.The proportion of workers who had premarital sexual behaviors in intervention group was lower than control group (10.9% vs 31.3%, P < 0.001).
  Ng’weshemi J. 1996 Cohort Tanzania 22 months Combination of education and community intervention
Sample size (before/after) 1433 workers /752 workers
Intervention 1. Health workers provided free and effective treatment of STD and testing HIV antibody every 5.5 months.
2. Health workers provided free condoms and HCT services in study clinic and factory.
3. Health workers provided health education activities, including information about HIV/AIDS, drama performance.
Outcome 1. Sexual partners: At a total of four follow-up at 22 months, the proportion of workers with sexual partners changed to: having one sexual partner (57.6, 68.4, 67.3, 70.2, and 72.9%, P < 0.001), having two sexual partners (17.6, 14.0, 12.2, 10.6, and 10.2%, P < 0.001), having three or more sexual partners (4.7, 4.1, 3.1, 2.3, and 2.0%, P = 0.012), and having casual partners (8.8, 6.8, 5.2, 4.4, and 4.6, P = 0.001)
2. Condom use: At a total of four follow- up at 22 months, the proportion of workers who reported to use condom during intercourse with casual partners were 7.6, 23.5, 41.0, 25.8, 27.3%, P = 0.002.
3. Sex behavior change: Low risk behavior (defined as none or one sexual partner) and high-risk behavior (defined as more than one sexual partner): With regard to the number of sexual partners in the last month, 61.7% reported low risk behavior at both the beginning and the end, 19.0% had changed from high to low, 12.2% continued high risk behavior, and 7.1% changed from low to high.
  Mekonnen Y 2003 Cohort Ethiopia 34 months Combination of education and community intervention
Sample size (before/after) 1124 workers /921 workers
Intervention 1. Health workers provided health education and HCT services.
2. Health workers offered free medical care to factory workers and their families.
Outcome Declined in the proportion of workers reporting recent casual sex (from 17.5 to 3.5%, P < 0.001), sex with commercial sex worker (from 11.2 to 0.75%, P < 0.001), and genital discharge (from 2.1 to 0.6%, P = 0.004).
  Sahlu T 2002 Cohort Ethiopia 25 months Combination of education and community intervention
Sample size (before/after) 757 workers /538 workers
Intervention Health workers provided HIV/AIDS health education, HCT services and free condoms in the factory.
Outcome 1. Declined in the proportion of males reporting recent casual sex (from 12 to 6.1%, P = 0.03), sex with sex worker (from 3.5 to 1.0%, P = 0.07), genital discharge (from 2.1 to 1.5%, P > 0.05), and genital ulcer (from 0.4 to 1.0%, P > 0.05) in the last 25 months.
2. Declined in the proportion of females reporting recent casual sex (from 2.2 to 0%, P = 0.03), genital discharge (from 12.9 to 8.9%, P > 0.05), and genital ulcer (from 3.6 to 2.1%, P > 0.05) in the last 25 months.
  Machekano R 2000 Cohort Zimbabwe 46 months Combination of peer education and community intervention
Sample size (before/after) 3383 workers /NR
Intervention 1. Providing HCT services, including individual risk assessment.
2. Peer educators provided free condoms in the workplace, organized HIV/AIDS prevention drama, and arranged presentations.
3. Peer educators led group discussions, distributed education materials, put up posters, and arranged video and slide shows.
Outcome 1. Whether to give peer education or not has no statistical significance for individuals whether to accept HCT. (odds ratio (OR) = 1.05, 95%CI: 0.92–1.20, P = 0.484)
2. Workers who received peer education were more willing to take their partners to HCT. (OR = 1.37, 95%CI: 1.04–1.79, P = 0.028)
3. Workers with STDs were more likely to accept HCT (OR = 2.78, 95%CI: 2.25 to 3.43) and took their partners to HCT (OR = 3.67, 95%CI: 2.90 to 4.63).
4. Workers who used to have ever paid for sex were more willing to go to HCT (OR = 1.27, 95%CI:1.09 to 1.49).
5. Worker with multiple sex partners were more likely to go to HCT (OR = 1.31, 95%CI: 1.14 to 1.50) and preferred to take their partners to HCT (OR = 1.46, 95%CI: 1.11 to 1.92).
  Weihs M 2014 Cohort South African 2 weeks Combination of lottery and community intervention
Sample size (before/after) 203 workers /NR
Intervention 1. The first step of the experimental intervention was the announcement of the lottery incentive system (LIS).
2. A leaflet was distributed to all workers approximately two weeks before workplace HCT services.
3. Workers who participated in workplace HCT would receive free t-shirts and would be entered into a company lottery which afforded opportunities to win gift cards (a first prize of 2000 South African rand (ZAR), a second prize of 500 ZAR, and 10 extra 100 ZAR prizes).
Outcome Compared with the pre- and post-intervention, the uptake rate of HCT increased from 30 to 85%, P < 0.001.
  Chamratrithirong A 2017 Cohort Thailand NR Combination of policy and education intervention
Sample size (before/after) Intervention group: 17 factories (NR/424 workers)
Control group: 11 factories (NR/275 workers)
Intervention 1. Policy intervention: To issue ASO certificates to factories, these factories must have non-discriminatory policies and confidentiality procedures for HIV-positive workers, support and care programs for HIV-infected workers, and have HIV/AIDS education programs for all workers, etc. 2. Distribution of free condoms and installation of condom vending machines. 3. Setting up HIV/AIDS exhibitions and handbooks.
Outcome This intervention method was significantly and positively related to HIV/AIDS knowledge (t = 2.834, P < 0.01), perceived condom accessibility (OR = 2.788 95%CI: 1.134 to 6.855, P < 0.05), and condom use with regular partners (OR = 1.247, 95%CI: 1.010, 1.540, P < 0.05).
  Weihs M 2018 Cohort South Africa 10 months Combination of lottery and community intervention
Sample size (before/after) Intervention group: 110 workers /101 workers
Control group: 88 workers /84 workers
Intervention 1. Firstly, educating all workers about HIV transmission, treatment, testing, and the importance of HCT;
2. Second, setting up HCT service points and issuing brochures for the intervention factories;
3. After 2 weeks, workers who participated in the workplace HCT could enter a lottery and had a chance to win money.
Outcome 1. Lottery intervention reduced HIV stigma among factory workers. (22.2% in intervention group, 9.6% in control group, P < 0.05)
2. HCT uptake in intervention group was higher than that in control group (53.6% in intervention group, 27.3% in control group, P < 0.001).
  1. Key: NR Not report; RCT Randomized control trial