Unité de Recherche en Santé des Populations, Centre de Recherche FRQS du CHA Universitaire de Québec, Québec, Canada.
J Acquir Immune Defic Syndr. 2013 May 1;63(1):126-34. doi: 10.1097/QAI.0b013e318286b9d4.
An HIV-preventive intervention targeting the sex work milieu and involving fully integrated components of structural interventions, communication for behavioral change and care for sexually transmitted infections (STIs), was implemented in Benin by a Canadian project from 1992 to 2006. It first covered Cotonou before being extended to other main cities from 2000. At the project end, the Beninese authorities took over the intervention, but structural interventions were interrupted and other intervention components were implemented separately. We estimated time trends in HIV/STI prevalence among female sex workers (FSWs) from 1993 to 2008 and assessed the impact of the change in intervention model on trends.
Six integrated biological and behavioral surveys were carried out among FSWs. Time trend analysis controlled for potential sociodemographic confounders using log-binomial regression.
In Cotonou, from 1993 to 2008, there was a significant decrease in HIV (53.3%-30.4%), gonorrhea (43.2%-6.4%), and chlamydia (9.4%-2.8%) prevalence (all adjusted P = 0.0001). The decrease in HIV and gonorrhea prevalence was also significant in the other cities between 2002 and 2008. In 2002, gonorrhea prevalence was lower in Cotonou than elsewhere (prevalence ratio = 0.53, 95% confidence interval: 0.32 to 0.88). From 2005 to 2008, there was an increase in gonorrhea prevalence (prevalence ratio = 1.76, 95% confidence interval: 1.17 to 2.65) in all cities combined.
Our results suggest a significant impact of this targeted preventive intervention on HIV/STI prevalence among FSWs. The recent increase in gonorrhea prevalence could be related to the lack of integration of the intervention components.
1992 年至 2006 年，加拿大在贝宁实施了一项针对性工作环境的艾滋病毒预防干预措施，该措施完全整合了结构干预、行为改变沟通和性传播感染（STI）护理等组成部分。该项目最初覆盖科托努，然后从 2000 年开始扩展到其他主要城市。项目结束时，贝宁当局接管了该干预措施，但结构干预被中断，其他干预措施分别实施。我们估计了 1993 年至 2008 年期间性工作者（FSW）中艾滋病毒/性传播感染（STI）的流行率，并评估了干预模式变化对趋势的影响。
对 FSW 进行了六次综合生物和行为调查。使用对数二项式回归控制潜在的社会人口混杂因素进行时间趋势分析。
在科托努，从 1993 年到 2008 年，艾滋病毒（53.3%-30.4%）、淋病（43.2%-6.4%）和衣原体（9.4%-2.8%）的流行率均显著下降（所有调整后 P=0.0001）。2002 年至 2008 年，其他城市的艾滋病毒和淋病流行率也显著下降。2002 年，科托努的淋病流行率低于其他地方（流行率比=0.53，95%置信区间：0.32 至 0.88）。2005 年至 2008 年，所有城市的淋病流行率均有所上升（流行率比=1.76，95%置信区间：1.17 至 2.65）。
我们的结果表明，这一有针对性的预防干预措施对 FSW 中的艾滋病毒/性传播感染流行率产生了重大影响。最近淋病流行率的上升可能与干预措施组成部分缺乏整合有关。
