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

撒哈拉以南非洲(SSA)的女性性工作者(FSWs)被确定为艾滋病的高危群体 艾滋病毒/艾滋病的传播，贫困地区和“艾滋病毒热点”的人特别容易受到伤害。研究表明， 研究表明，贫困女性从事商业性工作的主要原因是经济不稳定。考虑到这些 面对各种挑战，贫穷妇女除了需要艾滋病毒预防教育之外，还需要支持。我们建议测试一下 在传统艾滋病毒风险降低(HIVRR)中加入经济赋权(EE)成分的影响 Rakai和Masaka地区暗娼中性传播感染和艾滋病毒的新发病率 在乌干达。在社会认知和资产理论的指导下，这项研究为FSWs提供了一条探索的途径 替代性工作的安全和可持续收入的替代手段。这项研究是由以前的一位 在蒙古测试了对FSWs的小额信贷(MF)干预，与Masaka和Masha的FSWs进行了一项试点研究 Rakai，RHSP的监测研究，以及在乌干达受艾滋病影响的家庭中的EE干预。使用 集群设计我们将从33个匹配的城镇中心随机分配990名FSWs到三个研究部门中的一个(11 每种情况下的城镇中心)：(1)控制臂，由研究中的暗娼照常治疗(TAU)组成 由当地提供者提供的4次基于证据的HIVRR会议支持的区域(n=330)；或(2)A 治疗组，包括TAU，4次HIVRR，并收到匹配的储蓄账户 (HIVRR S)将根据参与者自己的情况用于短期和/或长期消费和技能发展 酌情(n=330)；或(3)包括TAU的治疗组，4个疗程的HIVRR，结合匹配的 储蓄账户将用于短期和/或长期消费和技能发展 学员自行决定，外加6个财务知识课程和8个辅导课程以获得支持 向替代收入选择过渡(HIVRR S家庭收入方案)(n=330)。这项随机对照研究的目的是：目标1： 使用艾滋病病毒携带者S和艾滋病携带者S研究以金融储蓄为主导的MF干预对艾滋病毒的影响 暗娼的生物学和行为结果(主要结果：妇女在生物学上的累积发病率 确诊的性传播感染和报告的无保护措施性行为的数量和比例，定期和有偿服务 二次结果：妇女新感染艾滋病毒病例的比率、每月性行为和非性收入的比例 性工作，报告的预防行为的数量和比例，仅对艾滋病毒妇女来说，病毒载量是一个标志 对艺术的坚持)。目标2：检查干预、调解和效果修正，以评估是否主要 结果受参与者特征的调节/调节；关键理论驱动的变量和 行为经济学衡量的是中介/适度干预结果。目标3：定性和 定量检查每项研究条件下的执行情况；目标4：评估成本和成本效益 S和S免疫缺陷病毒携带者与传统艾滋病病毒携带者的累计感染次数比较 在24个月的时间里，性传播感染和艾滋病毒病例得以避免。

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.