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 (FSW) 已被确定为高风险群体 艾滋病毒/艾滋病的传播，其中贫困地区和“艾滋病毒热点地区”尤其容易受到影响。研究有 表明贫困妇女从事商业性工作的主要原因是经济不稳定。鉴于这些 面对挑战，贫困妇女需要的支持不仅仅是艾滋病毒预防教育。我们建议测试 在传统的艾滋病毒风险降低 (HIVRR) 的基础上添加经济赋权 (EE) 的影响，以减少 拉凯和马萨卡地区性工作者中性传播感染（STI）和艾滋病毒的新发病率 在乌干达。该研究以社会认知和资产理论为指导，为FSWs提供了探索的途径 替代性工作的安全和可持续收入的替代方式。该研究是由先前的 在蒙古测试了对 FSW 的小额信贷 (MF) 干预，这是一项针对马萨卡和 FSW 进行的试点研究 Rakai、RHSP 的监测研究以及乌干达受艾滋病影响的家庭的 EE 干预措施。使用 集群设计中，我们将从 33 个匹配的城镇中心随机分配 990 名 FSW 到三个研究组之一（11 每种情况下的城镇中心）：(1) 对照组，包括对研究中的 FSW 进行照常治疗 (TAU) 由当地提供者提供的 4 场基于证据的 HIVRR 课程为该地区提供了支持（n=330）；或 (2) A 治疗组包括 TAU、4 次 HIVRR 疗程，并收到匹配的储蓄账户 (HIVRR+S) 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 酌情权（n=330）； (3) 一个治疗组，包括 TAU、4 次 HIVRR 疗程，并结合匹配的治疗方案 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 场金融知识课程和 8 场支持性辅导课程 过渡到替代收入选择 (HIVRR+S+FLM) (n=330)。本 RCT 研究的目的是： 目标 1： 检查使用 HIVRR+S 和 HIVRR+S+FLM 以财务储蓄为主导的 MF 干预措施对 HIV 的影响 FSW 的生物学和行为结果（主要结果：女性生物学行为的累计发生率） 确认的性传播感染以及报告的定期和付费无保护性行为的数量和比例 合作伙伴；次要结果：女性新发艾滋病毒病例的比率、来自性收入和非收入的月收入比例 性工作、报告的预防行为的数量和比例，并且仅针对艾滋病毒阳性女性，将病毒载量作为标记 ART 依从性）。目标 2：检查干预中介和效果修改，以评估是否是原发性的 结果由参与者特征调节/调节；关键理论驱动变量是否 行为经济学衡量中介/适度的干预结果。目标 3：定性和 定量检查每个研究条件的实施情况；目标 4：评估成本和成本效益 HIVRR+S 和 HIVRR+S+FLM 干预与传统 HIVRR 相比，在累计 24 个月内避免了性传播感染和艾滋病毒病例。