" Evaluating a Microeconomic Intervention for High Risk Women in India"

描述(由申请人提供)：本研究旨在评估一种新的微型企业随机临床试验干预对印度金奈女性性工作者(FSWs)艾滋病毒/性传播感染(STI)发病率的影响。人们越来越重视在艾滋病毒预防干预研究中解决结构性因素的必要性。POWER(通过经济赋权促进妇女机会)研究受到心理赋权和资产理论的启发。它还从对FSWs(N=100)的随机试点可行性研究中吸取的经验教训告诉我们，妇女对学习裁剪技能非常感兴趣，参与试点与性交易客户数量的减少、合法收入的增加和月收入的总体增加有关。本研究的目的是在金奈的FSWs(N=500)中，在6个月、12个月和18个月的随访中，确定袋子制作、定制微型企业干预和同等注意控制条件的有效性：减少HIV/STI的累积发病率(主要结果)以及性危险行为(例如，性伴侣的数量和无保护的阴道性行为)(目标1)；评估特定的个人、人际和经济因素是否中介干预对性危险行为的影响(目标2)；进行经济评价，以审查干预部门的成本、避免的每一次艾滋病毒感染的成本以及干预节省成本的盈亏平衡点(目标3)；并探索参与干预部门对妇女自尊、性关系中的性别平等以及对自己和家庭贡献的总体感觉的影响(目标4)。为了实现这些目标，参与者将被随机分配到两个手臂，并在6个月、12个月和18个月时进行跟踪。将通过在整个数据收集过程中进行的现有数据、观察和人种学绘图，从一系列以街道为基础的场所有针对性地抽样招募妇女。干预将包括两个，个人，项目尊重，艾滋病毒预防，测试前和测试后咨询会议，以及由经验丰富的教师以小组形式教授100小时的大师定制培训。平等注意控制臂还将包括两个单独的项目尊重课程，以及由成人教育教师教授的100小时的小组英语课程。所有参与者在每次访问时都将接受艾滋病毒/性传播感染检测。虽然裁剪有别于降低性风险，但我们假设，向妇女提供艾滋病毒预防工具，结合在同龄人中学习适销对路的技能的赋权和变革过程，将导致可持续的性传播感染风险降低。 公共卫生相关性：目前的研究将审查结构性干预措施对女性性工作者艾滋病毒/性传播感染累积发病率的影响，即经济赋权研究。最终，评估将提供这种干预的成本效益以及对艾滋病毒/性传播感染发病率和危险行为的影响。

DESCRIPTION (provided by applicant): The current study aims to evaluate the effects of a novel, microenterprise randomized clinical trial intervention on HIV/STI incidence among female sex workers (FSWs) in Chennai, India. There has been a growing attention for the need to address structural factors in HIV prevention intervention research. The POWER (Promoting Opportunities for Women through Economic Empowerment) study is informed by psychological empowerment and asset theories. It is also informed by lessons learned from a randomized, pilot, feasibility study of FSWs (N=100) which taught us that women were extremely interested in learning tailoring skills and that involvement in the pilot was associated with reductions in the number of sex trade clients, an increase in licit income, and an overall increase in monthly income. This current study aims to determine the efficacy of a bag-making, tailoring microenterprise intervention compared to an equal attention control condition among FSWs (N=500) in Chennai at 6-, 12-, and 18-month follow-up on: reducing cumulative HIV/STI incidence (primary outcome) as well sexual risk behaviors (e.g., number of sexual partners and unprotected vaginal sex) (Aim 1); assessing if specified intrapersonal, interpersonal, and economic factors mediate the intervention's effect on the sexual risk behaviors (Aim 2); conducting economic evaluations to examine the intervention arm's cost, cost per HIV infection averted, and the break-even point at which point the intervention is cost saving (Aim 3); and exploring the effects of participation in the intervention arm on women's self-esteem, gender equity in their sexual relationships, and overall feeling about themselves and their household contribution (Aim 4). To achieve these aims, participants will be randomly assigned to the two arms and will be followed at 6, 12, and 18 months. Women will be recruited through targeted sampling from a range of street-based venues identified through existing data, observations, and ethnographic mapping conducted throughout data collection. The intervention will be comprised of two, individual, Project RESPECT, HIV prevention, pre- and post-test counseling sessions plus 100 hours of master tailoring training taught in small groups from experienced instructors. The equal-attention control arm will also be comprised of the two, individual, Project RESPECT sessions plus 100 hours of small group, English lessons taught by adult education teachers. All participants will be HIV/STI tested at each visit. While tailoring is distinct from sexual risk reduction, we hypothesize that providing women HIV prevention tools combined with the empowering and transformative process of learning a marketable skill among peers, will lead to sustainable STI risk reduction. PUBLIC HEALTH RELEVANCE: The current study will examine the effects of a structural intervention on cumulative HIV/STI incidence among female sex workers, namely, an economic empowerment study. Ultimately, the evaluation will provide the cost effectiveness of such an intervention as well as the impact on HIV/STI incidence and risky behaviors.