TY - JOUR
T1 - Cluster randomized stepped-wedge trial of a multi-level HIV prevention intervention to decrease amphetamine-type stimulants and sexual risk in Cambodian female entertainment and sex workers
AU - Page, Kimberly
AU - Carrico, Adam W.
AU - Stein, Ellen
AU - Evans, Jennifer
AU - Sokunny, Muth
AU - Maly, Phou
AU - Sophal, Chhit
AU - Neak, Yuthea
AU - Ngak, Song
AU - McCulloch, Charles
AU - Maher, Lisa
N1 - Funding Information:
The authors would like to express our gratitude to the FHI360 field team for their dedication to the research: Chhim Srean for establishing data collection and management systems during early stages of the study and Len Aynar for later-stage oversight of data collection and management; Ean Nil for working closely with our team to develop and implement the CCT + AC intervention; Hong Naysim for her invaluable work in the field as a supervisor and facilitator for the aftercare groups; Nith Sopha and Mech Sotheary for their efforts in development of the ME financial literacy training curriculum; and Amy Weissman for supporting the implementation of this project in its early phases. We acknowledge the substantive contributions by Dr. Marie-Claude Couture to development of various study instruments and materials in the study planning phase. The authors would like to acknowledge the gracious and considerate involvement of the following organizations who supported the study and the participatns: Provincial Health Departments (PHD) , Provincial AIDS and STI program (PASP) , Pre-ART/ART clinics in 10 provinces , Chouk Sar Association and AID Health Foundation (AHF) . The authors are indebted and grateful for the ongoing support of numerous non-governmental organizations who made the implementation of this project possible: Cambodian Women for Peace and Development (CWPD) , Poor Family Development (PFD) , KHEMERA , Phnom Srey Organization for Development (PSOD) , Chamroen Microfinance Limited , and Vision Fund Cambodia . Finally, this research would not be possible without the support from the Cambodia National Ministry of Health Department Mental Health and Substance Abuse , the National Authority for Combating Drugs , and the National Center for HIV, AIDS, Dermatology and STDs . We are also grateful to the members of the Data Safety Monitoring Board, Steve Shiboski, Elise Riley, Paula Lum and Frits van Griensven, for volunteering their time and expertise to reviewing the study progress each year. Lisa Maher is supported by an Australian National Health and Medical Research Council Fellowship .
Funding Information:
Research reported in this paper was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number: R01-DA033672 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
KW - Amphetamine-type stimulants
KW - Conditional cash transfer
KW - Contingency management
KW - HIV prevention
KW - Microenterprise
KW - Sex work
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U2 - 10.1016/j.drugalcdep.2018.11.029
DO - 10.1016/j.drugalcdep.2018.11.029
M3 - Article
C2 - 30659994
AN - SCOPUS:85059950393
VL - 196
SP - 21
EP - 30
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -