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（FSWs）已被确定为艾滋病的高危人群