Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India

Piot, Bram; Mukherjee, Amajit; Navin, Deepa; Krishnan, N. V. H.; Bhardwaj, Ashish; Sharma, Vivek; Marjara, Pritpal

doi:10.1136/sti.2009.038356

Cited by 21 publications

(27 citation statements)

References 14 publications

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“…Other studies have found similar results supporting the claim that the condom supply was increased by Avahan [20]. The increase in peer educators as the source of condom by FSWs reported during the IBBA validated the CMIS condom distribution data.…”

Section: Discussionsupporting

confidence: 78%

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Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

et al. 2011

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BackgroundAvahan, the India AIDS Initiative has been a partner supporting targeted interventions of high risk populations under India’s National AIDS Control Organisation (NACO) since 2004 in the state of Maharashtra. This paper presents an assessment of the Avahan program among female sex workers (FSWs) in Maharashtra, its coverage, outcomes achieved and their association with Avahan program.MethodsAn analytical framework based on the Avahan evaluation design was used, addressing assessment questions on program implementation, intermediate outcomes and association of outcomes with Avahan. Data from routine program monitoring, two rounds of cross-sectional Integrated Behavioural and Biological Assessments (IBBAs) conducted in 2006 (Round 1- R1) and 2009 (Round 2 – R2) and quality assessments of program clinics were used. Bi-variate and multivariate analysis were conducted using the complex samples module in SPSS 15® (IBM, Somers NY).ResultsThe Avahan program achieved coverage of over 66% of FSWs within four years of implementation. The IBBA data showed increased contact by peers in R2 compared to R1 (AOR:2.34; p=0.001). Reported condom use with clients increased in R2 and number of FSWs reporting zero unprotected sex acts increased from 76.2% (R1) to 94.6% (R2) [AOR: 5.1, p=0.001].Significant declines were observed in prevalence of syphilis (RPR) (15.8% to 10.8%; AOR:0.54; p=0.001), chlamydia (8% to 6.2%; AOR:.0.65; p=0.010) and gonorrohoea (7.4% to 3.9; AOR:.0.60; p=0.026) between R1 and R2. HIV prevalence increased (25.8% to 27.5%; AOR:1.29; p=0.04). District-wise analysis showed decline in three districts and increase in Mumbai and Thane districts.FSWs exposed to Avahan had higher consistent condom use with occasional (94.3% vs. 90.6%; AOR: 1.55; p=0.04) and regular clients (92.5% vs. 86.0%; AOR: 1.95, p=0.001) compared to FSWs unexposed to Avahan. Decline in high titre syphilis was associated with Avahan exposure.ConclusionThe Avahan program was scaled up and achieved high coverage of FSWs in Maharashtra amidst multiple intervention players. Avahan coverage of FSWs was associated with improved safe sexual practices and declines in STIs. Prevalence of HIV increased requiring more detailed understanding of the data and, if confirmed, new approaches for HIV control.

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Section: Discussionsupporting

confidence: 78%

“…Free condoms distributed to FSWs by the program were tracked yearly from the Avahan CMIS and annual condom sales data from the condom social marketing program [20] in Maharashtra. Data on the reported sources of obtaining condom last time from IBBA were used to validate trends from the CMIS.…”

Section: Methodsmentioning

confidence: 99%

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

et al. 2011

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“…Exposure to media based communication on STIs and condom use was found to be a significantly associated with condom use; the studies by Lipovskey 13 , Suryawanshi 21 that evaluated condom use among clients who were exposed to media interventions reported condom use. A meta-analysis of the effect of social marketing efforts on condom use 22 also found increased likely hood of condom use; the interventions for clients of FSWs in the states sampled in IBBA were a combination of social marketing of condoms and media based campaigns 13,23 ; given the rigorous methodology of IBBA, the findings from the current analysis add to the evidence base for the efficacy of social marketing efforts.…”

Section: Discussionmentioning

confidence: 76%

Declining trends in risk behaviors and HIV/ STIs among Clients of FSWs in India: findings from large scale bio-behavioral surveys from three high prevalent Southern states

Ramakrishnan¹

2016

TIJPH

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Introduction There is increasing recognition of the importance of clients of FSW as bridge group to HIV transmission. However, there is paucity of evidence that establishes the HIV vulnerabilities or risk among clients in India. The current analysis examines the changes in risk behaviors (condom use), prevalence of HIV and STIs, and the factors associated with condom use behaviors among clients of sex workers in three Indian states using data from a large scale cross-sectional bio-behavioural survey. Methods Data were derived from two rounds of integrated behavioural and biological assessments (IBBA) conducted among clients in the years 2006 and 2009 in Andhra Pradesh, Tamil Nadu and Maharashtra, India. Eligible clients for the survey included men aged 18 years or older who had bought sex from a FSW at least once in the previous month.Two stage probability sampling was used and time location clusters sampling was applied. Consented participants completed structured interviews to collect behavioural data and provided blood and urine samples for HIV, Neisseria gonorrhea, Chlamydia trachomatis, and syphilis testing. Results Samples of 4,821 and 4,803 clients were covered in IBBA rounds 1 and 2, respectively. The majority of the clients were literate, ever married and worked as a laborer in two consecutive rounds. Over three fourth of clients had first paid sex before age 25 years. Clients of FSWs had a higher level of condom use during last sex act (AOR-2.5, 95% CI 1.9-3.3) and consistent condom use (AOR-3.1, 95% CI-2.1-3.9) with occasional FSWs during Round 2, compared with Round 1. Clients 24 years or younger (AOR=4.2; 95% CI: 2.9-6.2) were most likely to have reported consistent condom use with FSWs when compared with clients 40 years or older. Clients who reported having sex with other men, were less likely to report consistent condom use (AOR=0.63; 95% CI: 0.4-0.8) with FSWs. Clients who had exposure to messages on STIs or condom use through media advertising were significantly more likely to report consistent condom use with FSWs (AOR=1.6; 95% CI: 1.1-2.3). Logistic regression analysis of factors associated with having an STI indicates that clients having sex with another man have significantly higher likely hood of having an STI (9.1% versus 6.6%; AOR=1.8; 95% CI: 1.1-2.9). Conclusion The findings strongly suggest improvements in condom use among the bridge population, which is also confirmed by the non-increase in HIV and STI prevalence. Exposure to media messages on STIs and condom have shown to positively influence condom use. These findings have programmatic implications, in that it increases understanding about the sub-populations

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“…For example, Mechai Viravaidya's CBO, Population Development Association, raises money through revenue-maximizing businesses (e.g., restaurant and resort) which is then re-invested in family planning services and condom promotion, a model that has been recognized as a UNAIDS best practice [ 17 ]. Another example of SESH is social marketing to enhance uptake of condoms among sex workers, an approach that was found highly effective as part of the Avahan Initiative in India [ 18 ]. Social entrepreneurship models have slowly gained acceptance in a number of public health fields [ 19 ],[ 20 ], but are particularly important in sexual health where point-of-care tests are increasingly affordable and available.…”

Section: Introductionmentioning

confidence: 99%

Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models

et al. 2014

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BackgroundUNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability.MethodsWe undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data.ResultsOur qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing.ConclusionMany MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.

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Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India

Cited by 21 publications

References 14 publications

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

Declining trends in risk behaviors and HIV/ STIs among Clients of FSWs in India: findings from large scale bio-behavioral surveys from three high prevalent Southern states

Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models

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