National AIDS Research Institute (ICMR), Pune, India.
BMC Public Health. 2011 Dec 29;11 Suppl 6(Suppl 6):S2. doi: 10.1186/1471-2458-11-S6-S2.
BACKGROUND: Avahan, 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. METHODS: An 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). RESULTS: The 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. CONCLUSION: The 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.
背景：自 2004 年以来，印度艾滋病倡议（Avahan）一直是马哈拉施特拉邦国家艾滋病控制组织（NACO）支持高危人群有针对性干预措施的合作伙伴。本文评估了马哈拉施特拉邦女性性工作者（FSW）中的 Avahan 项目，包括其覆盖范围、取得的成果及其与 Avahan 项目的关联。
方法：使用基于 Avahan 评估设计的分析框架，解决了关于方案实施、中间成果以及成果与 Avahan 关联的评估问题。数据来自常规方案监测、2006 年（第一轮）和 2009 年（第二轮）进行的两轮综合行为和生物学评估（IBBA）以及方案诊所的质量评估。使用 SPSS 15（IBM，纽约萨默斯）中的复杂样本模块进行了双变量和多变量分析。
结果：Avahan 项目在实施四年内实现了超过 66%的 FSW 覆盖。IBBA 数据显示，与第一轮相比，第二轮中同行之间的联系有所增加（AOR：2.34；p=0.001）。报告与客户使用避孕套的比例在第二轮有所增加，报告零次无保护性行为的 FSW 比例从 76.2%（第一轮）增加到 94.6%（第二轮）[AOR：5.1，p=0.001]。梅毒（RPR）（15.8%降至 10.8%；AOR：0.54；p=0.001）、衣原体（8%降至 6.2%；AOR：0.65；p=0.010）和淋病（7.4%降至 3.9；AOR：0.60；p=0.026）的患病率均显著下降。HIV 患病率有所增加（从 25.8%升至 27.5%；AOR：1.29；p=0.04）。按地区分析显示，三个地区的患病率下降，而孟买和塔纳地区的患病率上升。与未接触 Avahan 的 FSW 相比，接触过 Avahan 的 FSW 与偶尔（94.3%对 90.6%；AOR：1.55；p=0.04）和常规客户（92.5%对 86.0%；AOR：1.95，p=0.001）使用避孕套的一致性更高。高滴度梅毒的下降与 Avahan 的暴露有关。
结论：Avahan 项目在马哈拉施特拉邦得到了扩展，实现了 FSW 的高覆盖，同时也有多个干预措施参与其中。Avahan 对 FSW 的覆盖与改善安全性行为和性传播感染的下降有关。HIV 的流行率有所上升，需要更详细地了解数据，如果得到证实，需要采取新的 HIV 控制方法。
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