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: 9769154
• 负责人: FRED M SSEWAMALA
• 金额: $ 61.85万
• 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/9769154
• 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; Preventive Intervention; 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; condoms; cost effectiveness; design; discount; discounting; empowerment; evidence base; experience; female sex worker; financial literacy; high risk; high risk population; improved; infection risk; innovation; insight; intervention participants; outreach; post 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; 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）已被确定为高危人群 艾滋病毒/艾滋病的传播，那些在贫困地区和“艾滋病毒热点”的传播特别容易受到伤害。研究有 表明，贫困妇女从事商业性工作的主要原因是金融不稳定。鉴于这些 挑战，贫困妇女需要超过预防艾滋病毒的教育。我们建议测试 将经济赋权（EE）组件增加到传统艾滋病毒风险降低（HIVRR）的影响以减少 Rakai和Masaka地区的FSW中，性传播感染（STI）和HIV的新事件 在乌干达。在社会认知和资产理论的指导下，该研究为FSW提供了探索的途径 安全和可持续收入的替代方法来取代性工作。该研究由以前的 对蒙古的FSW进行了测试的小额信贷（MF）干预，这是一项针对Masaka的FSW进行的试点研究 Rakai，RHSP的监视研究以及乌干达受艾滋病影响的家庭之间的EE干预措施。使用 群集设计我们将从33个匹配的城镇中心到三个研究臂之一，随机分配990 FSWS（11 在每种情况下的城镇中心）：（1）研究中FSW的控制臂完成治疗（TAU） 区域由本地提供商提供的4个基于循证的HIVRR的循证会议（n = 330）；或（2）a 包括tau在内的治疗臂，4次HIVRR，结合了匹配的储蓄帐户 （HIVRR+s）根据参与者自己的短期和/或长期消费和技能开发 酌处权（n = 330）;或（3）包括tau在内的治疗臂，4次HIVRR，与匹配 储蓄帐户将根据A的短期和/或长期消费和技能开发使用 参与者自己的酌处权加6个会议的金融素养和8个心理课程，以提供支持 过渡到替代收入选择（HIVRR+S+FLM）（n = 330）。此RCT研究的目的是：AIM1： 使用HIVRR+S和HIVRR+S+FLM对财务储蓄领导的MF干预的影响 FSW中的生物学和行为结果（主要结果：妇女在生物学上的累积发生率 确认的性传播感染，并报告了常规和付款的不受保护的性行为的数量和比例 合作伙伴；次要结局：妇女的新艾滋病毒案例，性别和非月度收入的比例 性工作，报告的预防行为数量和比例，仅针对艾滋病毒+女性，病毒载荷作为标记 艺术依从性）。目标2：检查干预调解和效果修改以评估主要是否 结果是由参与者特征介导/调节的；关键理论驱动的变量和 行为经济学衡量调解/中等干预结果。目标3：定性和 定量检查每个研究条件下的实施；目标4：评估成本和成本效益 与传统HIVRR相比，HIVRR+S和HIVRR+S+FLM干预的累积数 在24个月内，STI和HIV病例避免了。