Mackesy-Amiti Mary Ellen, Levy Judith A, Luc Casey M, Jonbekov Jonbek
School of Public Health, University of Illinois Chicago, Chicago, USA.
PRISMA Research Center, Dushanbe, Tajikistan.
medRxiv. 2024 Dec 13:2024.08.15.24312070. doi: 10.1101/2024.08.15.24312070.
In a cluster-randomized controlled trial, the "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) reduced intervention participants' sexual risk behaviour including any condomless sex, condomless sex with female sex workers, and multiple sexual partners. This analysis investigates if observed changes in sexual risk behaviors translated into fewer reported STIs among participants over 12-month follow-up.
The MASLIHAT intervention was tested in a cluster-randomized controlled trial with sites assigned to either the MASLIHAT intervention or comparison health education training (TANSIHAT). Participants and network members (n=420) were interviewed at baseline and 3-month intervals for one year to assess HIV/STI sex and drug risk behaviour. We conducted mixed effects robust Poisson regression analyses to test for differences between conditions in self-reported STIs during 12 months of follow-up, and to test the contribution of sexual risk behaviours to STI acquisition. We then tested the mediating effects of sexual behaviours during the first six months following the intervention on STIs reported at the 9 and 12-month follow-up interviews.
Participants in the MASLIHAT condition were significantly less likely to report an STI during follow-up (IRR=0.27, 95% CI 0.13-0.58). Condomless sex with a non-main (casual or commercial) partner was significantly associated with STI acquisition (IRR=2.30, 95% CI 1.26-4.21). Adjusting for condomless sex with a non-main partner, the effect of MASLIHAT intervention participation was reduced (IRR=0.36, 95% CI 0.16-0.80), signalling possible mediation. Causal mediation analysis indicated that the intervention's effect on reported STI was partially mediated by reductions among MASLIHAT participants in condomless sex with a non-main partner.
The MASLIHAT peer-education intervention reduced reported STIs among Tajik labour migrants partly through reduced condomless sex with casual and commercial partners.
ClinicalTrials.gov, 2021-04-16, NCT04853394.
在一项整群随机对照试验中，“塔吉克族移民艾滋病自我学习干预项目”（MASLIHAT）降低了干预参与者的性风险行为，包括任何无保护性行为、与女性性工作者的无保护性行为以及多个性伴侣。本分析调查了在12个月的随访中，观察到的性风险行为变化是否转化为参与者报告的性传播感染减少。
MASLIHAT干预在一项整群随机对照试验中进行测试，试验地点被分配到MASLIHAT干预组或对照健康教育培训组（TANSIHAT）。在基线时以及之后一年中每隔3个月对参与者和网络成员（n = 420）进行访谈，以评估艾滋病毒/性传播感染的性和药物风险行为。我们进行了混合效应稳健泊松回归分析，以测试随访12个月期间自我报告的性传播感染在不同条件之间的差异，并测试性风险行为对性传播感染感染的影响。然后，我们测试了干预后前六个月的性行为对在9个月和12个月随访访谈中报告的性传播感染的中介作用。
MASLIHAT组的参与者在随访期间报告性传播感染的可能性显著降低（发病率比[IRR]=0.27，95%置信区间[CI] 0.13 - 0.58）。与非主要（临时或商业）伴侣的无保护性行为与性传播感染感染显著相关（IRR = 2.30，95% CI 1.26 - 4.21）。在调整了与非主要伴侣的无保护性行为后，参与MASLIHAT干预的效果有所降低（IRR = 0.36，95% CI 0.16 - 0.80），这表明可能存在中介作用。因果中介分析表明，干预对报告的性传播感染的影响部分是由MASLIHAT参与者与非主要伴侣的无保护性行为减少所介导的。
MASLIHAT同伴教育干预部分通过减少与临时和商业伴侣的无保护性行为，降低了塔吉克劳务移民报告的性传播感染。
ClinicalTrials.gov，2021年4月16日，NCT04853394。
