FHI, India Country Office, India.
BMC Public Health. 2011 Dec 29;11 Suppl 6(Suppl 6):S10. doi: 10.1186/1471-2458-11-s6-s10.
Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data.
The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed.
A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period.
The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.
印度艾滋病倡议“阿伐哈”在印度六个艾滋病毒高流行率的邦实施了一项大型艾滋病毒预防方案，针对的是女性性工作者、高风险男男性行为者、跨性别者和注射吸毒者等高风险群体。利用个体追踪数据，对这些人群的临床服务利用情况、寻医行为和性传播感染综合征诊断趋势进行了测量。
阿伐哈临床监测系统包括高危人群临床服务的个体追踪数据。所有的诊所就诊都使用非政府组织级别的独特识别码记录在常规临床监测系统中。从 2005 年 1 月到 2009 年 12 月，对个体诊所就诊者进行了跟踪。对按风险群体分层的随时间变化的有限变量进行了分析。
共有 431434 人，包括 331533 名女性性工作者、10280 名注射吸毒者、82293 名男男性行为者和 7328 名跨性别者，共进行了 2700192 次就诊。在研究期间，个体平均到诊所就诊 6.2 次。每人每年的就诊次数从 2005 年的 1.2 次增加到 2009 年的 8.3 次。每年到诊所就诊超过 4 次的就诊者比例从 2005 年的 4%增加到 2009 年的 26%（p<0.001）。女性性工作者中诊断出的性传播感染综合征比例从 2005 年的 39%下降到 2009 年的 11%（p<0.001），而高风险男男性行为者中诊断出的性传播感染综合征比例从 12%下降到 3%（p<0.001）。定期接受性传播感染检查的就诊者比例从 12%增加到 48%（p<0.001）。在方案实施期间，高风险群体在出现性传播感染相关症状后两天内就诊并接受阴道镜和直肠镜检查的比例显著增加。
该方案表明，通过标准化方法，可以将可接受和可及的服务提供给边缘化且通常难以接触的人群，并将其推广到非常大的规模。这些服务的利用可以显著改善寻医行为并降低性传播感染的流行率。
