Concepts and strategies for scaling up focused prevention for sex workers in India

Blanchard, James; Bhattacharjee, P; Kumaran, S.; Ramesh, B M; Kumar, Neelam; Washington, Reynold; Moses, Stephen

doi:10.1136/sti.2008.033134

Cited by 37 publications

(36 citation statements)

References 12 publications

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“…In brief, a combination of extensive geographical and social mapping in urban and peri-urban areas with repeated, intensive Delphi techniques and focus group discussions with key informants (target populations, influencers) was used to arrive at district-wide denominators [73][74][75]. In addition, the evaluation partner responsible for running cross-sectional surveys among the target population was also charged with independently generating and validating size estimates with alternative methods (multiplier, capture-recapture, multistage sampling) in the subset of districts [13].…”

Section: Methods To Answer Epidemic Impact Questionsmentioning

confidence: 99%

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Chandrasekaran¹,

Dallabetta²,

Loo³

et al. 2008

Aids

112

114

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Section: Methods To Answer Epidemic Impact Questionsmentioning

confidence: 99%

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Chandrasekaran¹,

Dallabetta²,

Loo³

et al. 2008

Aids

112

114

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“…Exposure to service was defined as an aggregate variable based on proportion of FSW who reported having received any or all of the following core programme services in the past year (regardless of service provider):23 (1) contacted by a peer educator, (2) visited the programme clinic for STI services and (3) received condoms from peer or outreach workers 9 27. These are the three core services referred to in this paper.…”

Section: Methodsmentioning

confidence: 99%

Programme coverage, condom use and STI treatment among FSWs in a large-scale HIV prevention programme: results from cross-sectional surveys in 22 districts in southern India

Ramakrishnan¹,

Gautam²,

Goswami³

et al. 2010

Sexually Transmitted Infections

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ObjectiveThis paper evaluates Avahan programme's coverage of female sex workers (FSWs), focus on high-risk FSWs and intermediate outcomes.MethodsFirst round of cross-sectional survey data, Integrated Behavioral and Biological Assessments (IBBA), conducted in 22 districts, were aggregated into district categories: Solo, where Avahan was the sole service provider covering all FSWs and Major or Minor where Avahan was not the sole provider, but intended coverage was >50% or ≤ 50% of FSWs respectively. Multivariate logistic regression was applied to compare exposure by district categories, vulnerability factors and intermediate outcomes associated with exposure.ResultsReported exposure, evaluated on basis of having received any of three core services, was higher in Solo (75%) compared with Minor (66%) districts. Logistic regression showed that FSWs in solo districts were more likely to be exposed (adjusted odds ratio (AOR)=1.5; 95% CI 1.20 to 1.86) compared with FSWs in Minor districts. Multivariate analysis in Solo districts revealed that FSW with ≥15 clients in the past week had a higher chance of being exposed to core services (AOR=1.56; 95% CI 1.03 to 2.35). Exposure to the three services in Solo Avahan districts was significantly associated with correct knowledge on condom use (AOR=1.36; 95% CI 1.05 to 1.78), consistent condom use with occasional clients (AOR=3.17; 95% CI 2.17 to 4.63) and regular clients (AOR=2.47; 95% CI 1.86 to 3.28) and STI treatment-seeking behaviour (AOR=3.00; 95% CI 1.94 to 4.65).ConclusionsHigher coverage of FSWs was achieved in districts where Avahan was the only intervention compared with districts having multiple and longstanding non-Avahan programmes. Exposure in Solo districts was associated with intermediate outcomes; this need to be further evaluated in comparison with non Avahan areas and substantiated through data from next IBBA.

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“…Programmes begin with mapping to locate and estimate sizes of target populations. 23 Contacts made during this formative stage provide the initial building blocks for peer-based interventions. Peer workers have been shown to be most effective in catalysing change in their communities, from condom use to clinic attendance to structural changes.…”

Section: Targeting High-risk Populationsmentioning

confidence: 99%

Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm

Steen¹,

Wi²,

Kamali³

et al. 2009

Bull World Health Org

116

103

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Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poor STI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics.STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data.Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations.STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬ a

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Concepts and strategies for scaling up focused prevention for sex workers in India

Abstract: A strategy that involves geographically defined coverage and micro-level outreach planning can rapidly and effectively provide outreach and services to large dispersed FSW populations.

Cited by 37 publications

References 12 publications

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Programme coverage, condom use and STI treatment among FSWs in a large-scale HIV prevention programme: results from cross-sectional surveys in 22 districts in southern India

Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm

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