Kyaterekera Project: A Combination Intervention Addressing Sexual Risk-Taking Behaviors Among Vulnerable Women in Uganda

Kyaterekera 项目：解决乌干达弱势妇女性冒险行为的综合干预措施

• 批准号: 10175046
• 负责人: FRED M SSEWAMALA
• 金额: $ 60.79万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-24 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175046
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Affect; Africa South of the Sahara; Area; Behavior; Behavioral; Biological; Businesses; Caring; Characteristics; Chlamydia; Cognitive; Community Outreach; Consumption; Cost Analysis; Development; Economics; Education; Family; Fostering; Future; Gonorrhea; HIV; HIV Infections; HIV risk; Health Sciences; Health education; Healthcare; Hour; Human immunodeficiency virus test; Incidence; Income; Infection; Intervention; Intervention Studies; Lead; Measures; Mediating; Mediation; Mentors; Mentorship; Modification; Mongolia; Nigeria; Nongovernmental Organizations; Outcome; Outcome Study; Participant; Perception; Pilot Projects; Population; Prevalence; Prevention; Prevention education; Preventive; Process; Prostitution; Provider; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Rest; Risk Behaviors; Risk Reduction; Savings; Scientist; Seroprevalences; Sexual Transmission; Sexually Transmitted Diseases; South Africa; Structure; Target Populations; Testing; Time; Trichomonas; Uganda; Viral Load result; Vocational Education; Woman; Work; Youth; arm; base; behavioral economics; behavioral outcome; comparison intervention; condoms; cost effectiveness; design; discounting; empowerment; evidence base; experience; female sex worker; financial literacy; high risk; high risk population; implementation facilitators; improved; infection risk; innovation; insight; intervention participants; outreach; post intervention; preventive intervention; primary outcome; programs; public health priorities; public health relevance; recruit; satisfaction; scale up; screening; secondary outcome; sex; sexual risk taking; skill acquisition; skills; social; social structure; surveillance study; testing services; theories; three-arm study; treatment arm; treatment as usual; uptake

Female Sex Workers (FSWs) in sub-Saharan Africa (SSA) have been identified as a high-risk group for the spread of HIV/AIDS, with those in poor areas and “HIV hotspots” being especially vulnerable. Research has shown that the primary reason poor women engage in commercial sex work is financial instability. Given these challenges, poor women require support over and above HIV prevention education. We propose to test the impact of adding economic empowerment (EE) components to traditional HIV risk reduction (HIVRR) to reduce new incidence of sexually transmitted infections (STIs) and of HIV among FSWs in Rakai and Masaka districts in Uganda. Guided by social-cognitive and asset theories, the study provides an avenue for FSWs to explore alternative means of safe and sustainable income to replace sex work. The study is informed by a previously tested microfinance (MF) intervention for FSWs in Mongolia, a pilot study conducted with FSWs in Masaka and Rakai, surveillance studies by RHSP, and EE interventions among AIDS-affected families in Uganda. Using a cluster-design we will randomly assign 990 FSWs from 33 matched town centers to one of three study arms (11 town centers in each condition): (1) A control arm comprising of treatment as usual (TAU) for FSWs in the study area bolstered with 4 evidence-based sessions of HIVRR provided by local providers (n=330); or (2) A treatment arm including TAU, 4 sessions of HIVRR, combined with receipt of a matched savings account (HIVRR+S) to be used on short- and/or long-term consumption and skills development as per participants’ own discretion (n=330); or (3) A treatment arm including TAU, 4 sessions of HIVRR, combined with a matched savings account to be used on short-term and/or long term consumption and skills development as per a participant’s own discretion plus 6 sessions of financial literacy and 8 mentoring sessions for supportive transition to alternative income options (HIVRR+S+FLM) (n=330). This RCT study’s aims are to: Aim1: Examine the impact of a financial savings-led MF intervention using HIVRR+S and HIVRR+S+FLM on HIV biological and behavioral outcomes in FSWs (Primary outcomes: women’s cumulative incidence of biologically- confirmed STIs and reported number and proportion of unprotected sexual acts with regular and paying partners; Secondary outcomes: women’s rate of new HIV cases, proportion of monthly income from sex and non- sex work, reported number and proportion on preventive behaviors, and for HIV+ women only, viral load as a marker of ART adherence). Aim 2: Examine intervention mediation and effect modification to assess whether primary outcomes are mediated/moderated by participant characteristics; whether key theory-driven variables and Behavioral Economics measures mediate/moderate intervention outcomes. Aim 3: Qualitatively and quantitatively examine implementation in each study condition; and Aim 4: Assess the cost and cost-effectiveness of the HIVRR+S and HIVRR+S+FLM intervention compared with traditional HIVRR in terms of cumulative number of STI and HIV cases averted over the 24-month period.

撒哈拉以南非洲（SSA）的女性性工作者（FSW）已被确定为高风险群体， 艾滋病毒/艾滋病的蔓延，贫困地区和“艾滋病毒热点”的人特别容易受到伤害。研究 贫穷妇女从事商业性工作的主要原因是经济不稳定。鉴于这些 面对这些挑战，贫穷妇女需要的支助不只是艾滋病毒预防教育。我们建议测试 在传统的减少艾滋病毒风险（HIVRR）中增加经济赋权（EE）的影响， Rakai和马萨卡区性工作者中性传播感染和艾滋病毒的新发病率 在乌干达。在社会认知理论和资产理论的指导下，本研究为女性性工作者提供了一条探索的途径 以安全和可持续的收入替代性工作。这项研究是由一个以前的 在蒙古测试了对FSW的小额信贷干预，在马萨卡对FSW进行了试点研究， Rakai、生殖健康项目的监测研究和乌干达受艾滋病影响家庭的环境教育干预。使用 我们将从33个匹配的城镇中心随机分配990名FSW到三个研究组（11 （1）对照组，包括研究中FSW的常规治疗（TAU 由当地提供者提供的4次循证HIVRR会议支持的区域（n=330）;或（2）A 治疗组，包括TAU，4次HIVRR治疗，并收到匹配的储蓄账户 （艾滋病毒/艾滋病防治方案+S）用于短期和/或长期消费和技能发展，由参与者自己决定 酌情（n=330）;或（3）治疗组，包括TAU，4次HIVRR，结合匹配的 储蓄账户用于短期和/或长期消费和技能发展， 参与者自行决定，加上6个金融知识课程和8个支持性指导课程 过渡到其他收入选择（HIVRR+S+FLM）（n=330）。本RCT研究的目的是：Aim 1： 检查使用HIVRR+S和HIVRR+S+FLM的金融储蓄引导的MF干预对艾滋病毒的影响 FSW的生物和行为结果（主要结果：女性的生物- 已确认的性传播感染以及报告的定期和付费的无保护性行为的数量和比例 次要结果：妇女的艾滋病毒新病例率、性收入和非性收入占月收入的比例 性工作、报告的预防行为的数量和比例，以及仅针对艾滋病毒阳性妇女的病毒载量作为标志 坚持艺术）。目的2：检查干预中介和效果调整，以评估是否主要 结果是中介/主持的参与者的特点;是否关键的理论驱动的变量， 行为经济学测量中介/中度干预结果。目标3：质量和 定量地检查每个研究条件下的实施情况;目标4：评估成本和成本效益 与传统的HIVRR相比，HIVRR+S和HIVRR+S+FLM干预的累积数量 在24个月期间避免了性传播感染和艾滋病毒病例。