National Institute of Epidemiology (ICMR), Second Main Road, TNHB, Ayapakkam, Chennai 600 077, India.
BMC Public Health. 2011 Dec 29;11 Suppl 6(Suppl 6):S3. doi: 10.1186/1471-2458-11-S6-S3.
Avahan, the India AIDS Initiative, a large-scale HIV prevention program, using peer-mediated approaches and STI services, was implemented for high-risk groups for HIV in six states in India. This paper describes the assessment of the program among female sex workers (FSWs) in the southern state of Tamil Nadu.
An analytical framework based on the Avahan impact evaluation design was used. Routine program monitoring data, two rounds of cross-sectional biological and behavioural surveys among FSWs in 2006 (Round 1) and 2009 (Round 2) and quality assessments of clinical services for sexually transmitted infections (STIs) were used to assess trends in coverage, condom use and prevalence of STIs, HIV and their association with program exposure. Logistic regression analysis was used to examine trends in intermediate outcomes and their associations with intervention exposure.
The Avahan program in Tamil Nadu was scaled up and achieved monthly reported coverage of 79% within four years of implementation. The cross-sectional survey data showed an increasing proportion of FSWs being reached by Avahan, 54% in Round 1 and 86% in Round 2 [AOR=4.7;p=0.001]. Quality assessments of STI clinical services showed consistent improvement in quality scores (3.0 in 2005 to 4.5 in 2008). Condom distribution by the program rose to cover all estimated commercial sex acts. Reported consistent condom use increased between Round 1 and Round 2 with occasional (72% to 93%; AOR=5.5; p=0.001) and regular clients (68% to 89%; AOR=4.3; p=0.001) while reactive syphilis serology declined significantly (9.7% to 2.2% AOR=0.2; p=0.001). HIV prevalence remained stable at 6.1% between rounds. There was a strong association between Avahan exposure and consistent condom use with commercial clients; however no association was seen with declines in STIs.
The Avahan program in Tamil Nadu achieved high coverage of FSWs, resulting in outcomes of improved condom use, declining syphilis and stabilizing HIV prevalence. These expected outcomes following the program logic model and declining HIV prevalence among general population groups suggest potential impact of high risk group interventions on HIV epidemic in Tamil Nadu.
作为一个大规模的艾滋病毒预防项目，印度艾滋病倡议（Avahan）采用同伴介导的方法和性传播感染（STI）服务，在印度六个邦为艾滋病毒高危人群实施。本文描述了在印度南部泰米尔纳德邦的女性性工作者（FSWs）中对该项目的评估。
采用基于 Avahan 影响评估设计的分析框架。使用常规方案监测数据、2006 年（第一轮）和 2009 年（第二轮）对 FSWs 进行的两轮横断面生物学和行为调查以及对性传播感染（STI）临床服务的质量评估，评估了覆盖范围、 condom 使用和 STI、HIV 的流行趋势及其与方案接触的关联。使用逻辑回归分析检查中间结果的趋势及其与干预接触的关联。
泰米尔纳德邦的 Avahan 项目规模扩大，在实施四年内每月报告的覆盖率达到 79%。横断面调查数据显示，Avahan 覆盖的 FSWs 比例不断增加，第一轮为 54%，第二轮为 86%[AOR=4.7;p=0.001]。STI 临床服务质量评估显示，质量评分持续改善（2005 年 3.0 分至 2008 年 4.5 分）。该方案的 condom 分发量增加到涵盖所有估计的商业性行为。第一轮和第二轮之间，偶尔（72%至 93%；AOR=5.5；p=0.001）和定期客户（68%至 89%；AOR=4.3；p=0.001）的 condom 使用率持续增加，而反应性梅毒血清学则显著下降（9.7%至 2.2%，AOR=0.2；p=0.001）。两轮之间 HIV 流行率保持稳定，为 6.1%。Avahan 接触与与商业客户一致 condom 使用之间存在很强的关联；然而，在 STI 下降方面没有关联。
泰米尔纳德邦的 Avahan 项目实现了对 FSWs 的高覆盖率，导致 condom 使用增加、梅毒减少和 HIV 流行率稳定的结果。这些结果符合方案逻辑模型，并且泰米尔纳德邦一般人群组的 HIV 流行率下降，表明高危人群干预措施对该邦 HIV 流行的潜在影响。
