Kimberly Page1, Adam W Carrico2, Ellen Stein3, Jennifer Evans4, Muth Sokunny5, Phou Maly6, Chhit Sophal7, Yuthea Neak8, Song Ngak9, Charles McCulloch10, Lisa Maher11. 1. Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University New Mexico Health Sciences Center, Albuquerque, NM, USA; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Pagek@salud.unm.edu. 2. Department of Public Health Sciences, Division of Prevention Science and Community Health, University of Miami, Miami, FL, USA; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: A.Carrico@miami.edu. 3. Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Ellen.Stein@ucsf.edu. 4. Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Jennifer.Evans@ucsf.edu. 5. FHI 360, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: msokunny@gmail.com. 6. FHI 360, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: malyphoupsy@gmail.com. 7. Ministry of Health, Department of Mental Health and Substance Abuse, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Chhit_Sophal@hotmail.com. 8. National Authority for Combating Drugs, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: neakyuthea@yahoo.com. 9. FHI 360, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Sngak@fhi360.com. 10. Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Charles.McCulloch@ucsf.edu. 11. Ministry of Health, Department of Mental Health and Substance Abuse, Phnom Penh, Cambodia; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia. Electronic address: Lisa.Maher@kirby.unsw.edu.au.
Abstract
BACKGROUND: HIV prevention for female entertainment and sex workers (FESW) may be optimized by addressing individual and structural risks. We examined the impact of a sequentially delivered intervention to decrease sexual risk, amphetamine-type stimulant (ATS) use, and improve economic well-being in Cambodian FESW. METHODS: A cluster randomized stepped-wedge trial was conducted in 10 Cambodian provinces to test multi-level intervention in high risk FESW. After baseline screening in 1198 women, those screening positive for ATS use disorder were allocated to a 12-week conditional cash transfer intervention followed by a 4-week cognitive-behavioural aftercare group (CCT + AC). At six months, ATS abstinent participants were offered a microenterprise (ME) opportunity. Co-primary outcomes assessed in 600 FESW at each 6-, 12- and 18-month follow-up assessments, included: 1) number of sexual partners (past three months); and 2) ATS urine toxicology positive (Tox+) results. Secondary outcomes included indicators of economic well-being. RESULTS: Relative to baseline, FESW reported fewer sexual partners at all follow-up assessments with a significant 50% decrease at 12-months (Adjusted Rate Ratio [ARR] = 0.50; 95%CI: 0.25, 0.95). Women had 60% lower odds of being ATS Tox+ (Adjusted Odds Ratio [AOR] = 0.40; 95%CI: 0.25, 0.65) at 6-months, and continued but non-significant reductions at 12- and 18-months. Improvements in economic well-being indicators were observed at 12- and 18-months. CONCLUSIONS: Findings support the robust effectiveness of the sequentially delivered CCT + AC and ME interventions for boosting HIV prevention for Cambodian FESW. Further research is needed to inform the scale up and improve durability of this comprehensive approach with FESW in Southeast Asia.
RCT Entities:
BACKGROUND: HIV prevention for female entertainment and sex workers (FESW) may be optimized by addressing individual and structural risks. We examined the impact of a sequentially delivered intervention to decrease sexual risk, amphetamine-type stimulant (ATS) use, and improve economic well-being in Cambodian FESW. METHODS: A cluster randomized stepped-wedge trial was conducted in 10 Cambodian provinces to test multi-level intervention in high risk FESW. After baseline screening in 1198 women, those screening positive for ATS use disorder were allocated to a 12-week conditional cash transfer intervention followed by a 4-week cognitive-behavioural aftercare group (CCT + AC). At six months, ATS abstinent participants were offered a microenterprise (ME) opportunity. Co-primary outcomes assessed in 600 FESW at each 6-, 12- and 18-month follow-up assessments, included: 1) number of sexual partners (past three months); and 2) ATS urine toxicology positive (Tox+) results. Secondary outcomes included indicators of economic well-being. RESULTS: Relative to baseline, FESW reported fewer sexual partners at all follow-up assessments with a significant 50% decrease at 12-months (Adjusted Rate Ratio [ARR] = 0.50; 95%CI: 0.25, 0.95). Women had 60% lower odds of being ATSTox+ (Adjusted Odds Ratio [AOR] = 0.40; 95%CI: 0.25, 0.65) at 6-months, and continued but non-significant reductions at 12- and 18-months. Improvements in economic well-being indicators were observed at 12- and 18-months. CONCLUSIONS: Findings support the robust effectiveness of the sequentially delivered CCT + AC and ME interventions for boosting HIV prevention for Cambodian FESW. Further research is needed to inform the scale up and improve durability of this comprehensive approach with FESW in Southeast Asia.
Authors: Ji-Young Lee; Kimberly Page; Ellen Stein; Jennifer L Evans; Muth Sokunny; Phou Maly; Chhit Sophal; Song Ngak; Lisa Maher; Adam W Carrico Journal: AIDS Behav Date: 2020-03