Transitions: Novel Study Methods to Understand Early HIV Risk Among Adolescent Girls and Young Women in Mombasa, Kenya, and Dnipro, Ukraine

Abstract

Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts (Mombasa, Kenya, and Dnipro, Ukraine); (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events (first sex, first exchange of sex for money or other resources, self-identification as sex workers, entry into formal sex work, access to prevention program services); sexual behaviors (condom use, anal sex, sex under the influence of drugs or alcohol); partnerships (regular and first-time clients, regular and Cheuk et al. The Transitions Study first-time transactional sex partners, and husbands and boyfriends); alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health (pregnancies, abortions, contraceptives). HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts.

HIV prevention programme with young women who sell sex in Mombasa, Kenya: learnings for scale‐up

“…The study was conducted in Kisauni sub‐county, one of the six sub‐counties in Mombasa, Kenya. Key population size estimation conducted in 2014 showed that Kisuani had the highest number of YWSS compared to other sub‐counties (41% of the total estimated YWSS population) [ 8 ]. ICRH‐K, the implementing partner in the project, has a long‐standing HIV prevention programme with FSWs in the county.…”

“…In 2018, there were an estimated 15,000 female sex workers (FSWs) <below 18 years of age in Kenya [ 7 ]. Mapping and size estimation data from the Transitions study [ 8 ] conducted in sex work venues in Mombasa, Kenya, have shown that 52% of all estimated FSWs were 14–24 years old [ 9 ], with an HIV prevalence of 10% among self‐identified YWSS compared to 4% among non‐YWSS of the same age [ 10 ]. The same study also revealed that YWSS in these venues reported higher experience of violence compared to those who were not selling sex [ 11 ].…”

Evaluation of the bioMérieux VIDAS HIV Duo Quick and Anti-HCV assays for dried blood spot based serosurveillance

“…The Transitions study is a cross-sectional integrated biological and behavioural survey conceived to measure the prevalence and patterns of HIV risk and vulnerabilities 26 – 28 . From March to December 2015, field teams in the city of Dnipro, Ukraine administered written informed consent, conducted interviews, and oversaw multiplex rapid testing for HIV, syphilis, and hepatitis B and C (Profitest Combo, New Vision Diagnostics, Haicang Xiamen, China) among study participants.…”

Awareness and Utilization of HIV Testing and Prevention Services Among Female Sex Workers in Dnipro, Ukraine: Implications for Prevention Program Strengthening From the Dynamics Study

“…Data collection continued until the target sample of 560 participants had been interviewed, facilitated by the close cooperation of social mobilizers, who communicated the importance and relevance of the study to participants. Survey questions were informed by Integrated Biological and Behavioral Survey Guidelines ( 23 ), as well as other sex worker surveys, including the Transitions study ( 24 ), an earlier study piloted and locally validated in Dnipro. Participants were asked questions about basic socio-demographics, experiences of sex work, access to HIV prevention and care programs and related services, and HIV testing behaviors.…”