社区赋权干预对马里兰州巴尔的摩市女性性工作者性传播感染的影响。

Impact of a Community Empowerment Intervention on Sexually Transmitted Infections Among Female Sex Workers in Baltimore, Maryland.

作者信息

Sherman Susan G, Tomko Catherine, Nestadt Danielle F, Silberzahn Bradley E, Clouse Emily, Haney Katherine, Allen Sean T, Galai Noya

机构信息

From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Department of Sociology, University of Texas at Austin, Austin, TX.

出版信息

Sex Transm Dis. 2023 Jun 1;50(6):374-380. doi: 10.1097/OLQ.0000000000001781. Epub 2023 Feb 8.

DOI:10.1097/OLQ.0000000000001781

PMID:36749851

Abstract

BACKGROUND

Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States.

METHODS

Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals.

RESULTS

Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04).

CONCLUSIONS

Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.

摘要

背景

女性性工作者易面临多种健康问题，但由于结构性障碍，她们往往延迟寻求医疗保健。多服务即到即诊中心已被证明能在全球范围内增加女性性工作者获得医疗服务的机会，但在美国其对女性性工作者的影响尚不清楚。本研究旨在评估社区层面的赋权干预措施（多服务即到即诊的SPARC中心）对美国某城市女性性工作者累积性传播感染（STIs）的影响。

方法

2017年9月至2019年1月期间，在巴尔的摩招募了385名女性性工作者。来自SPARC服务区域的参与者被招募到干预组；巴尔的摩的其他区域作为对照组。在6个月、12个月和18个月时进行随访。主要结局是累积性传播感染（即在任何一次随访中淋病或衣原体检测呈阳性）。我们根据基线时报告的与付费客户无保护性行为情况检验效应修正。使用倾向得分加权的逻辑回归来估计干预效果，并考虑失访情况，采用自助法置信区间。

结果

参与者完成了713次随访研究访视（在6个月、12个月和18个月时的保留率分别为73%、70%和64%）。基线时性传播感染患病率为28%，随访期间累积性传播感染患病率为26%；在双变量分析中，对照组和干预组社区之间这两个患病率均无差异。在调整协变量后，与对照组相比，干预组女性性工作者累积性传播感染的几率有边缘显著降低（优势比，0.61；P = 0.09）。有证据表明存在基线无保护性行为的效应修正，即与对照组中也报告基线无保护性行为的女性性工作者相比，干预组中报告无保护性行为的女性性工作者累积性传播感染的几率更低（优势比，0.29；P = 0.04）。