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Increased HIV prevention program coverage and decline in HIV prevalence among female sex workers in South India

机译：南印度女性性工作者的艾滋病毒预防计划覆盖面增加，艾滋病毒流行率下降

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BACKGROUND: As one way of assessing the impact of Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation, we examined the association between HIV prevention program indicators and changes in HIV prevalence among female sex workers (FSWs) between 2005 and 2009. METHODS: We conducted a secondary data analysis from 2 large cross-sectional surveys (2005-2006 and 2008-2009) across 24 districts in south India (n = 11,000 per round). A random-effect multilevel logistic regression analysis was performed using HIV as the outcome, with individual independent variables (from both surveys) at level 1 and district-level FSW-specific program indicators and contextual variables at level 2. Program indicators included their 2006 value, the difference in their values between 2008 and 2006, and the interaction between this difference and study round. RESULTS: HIV prevalence among FSWs decreased from 17.0% to 14.2% (P < 0.001). This decline varied significantly (P = 0.006) across levels of difference in program coverage (% of FSWs contacted by the program in a given year). Odds ratios comparing HIV prevalence between rounds changed with the level of increase in coverage and were statistically significant with coverage increase ≥ quartile (Q) 1: odds ratio, 0.85 at Q1; 0.78 at Q2; 0.66 at Q3; and 0.51 at Q4. CONCLUSIONS: These findings suggest that increased program coverage was associated with declining HIV prevalence among FSWs covered by the Avahan program. The triangulation of our results with those from other approaches used in evaluating Avahan suggests a major impact of this intervention on the HIV epidemic in southern India.
机译：背景：作为评估比尔和梅琳达·盖茨基金会的印度艾滋病行动Avahan的一种方法，我们研究了2005年至2009年之间艾滋病毒预防计划指标与女性性工作者（FSW）艾滋病毒流行率变化之间的关联。方法：我们从印度南部24个地区的2个大型横断面调查（2005-2006年和2008-2009年）中进行了二次数据分析（每轮n = 11,000）。使用艾滋病毒作为结果进行了随机影响的多级logistic回归分析，第一级的个人独立变量（来自两个调查），第二级的地区级FSW特定计划指标和第二级上下文变量。计划指标包括其2006年的价值，它们在2008年和2006年之间的价值差异以及这种差异与研究回合之间的相互作用。结果：FSW中的艾滋病毒流行率从17.0％下降到14.2％（P <0.001）。在计划覆盖范围的不同水平（在特定年份中，计划联系的FSW的百分比）之间的差异显着（P = 0.006）。比较各轮之间的艾滋病病毒感染率的赔率随着覆盖率的增加水平而变化，并且在覆盖率增加≥四分位数（Q）1：优势比，第一季度为0.85时，具有统计学意义;第二季度为0.78;第三季度为0.66;在第四季度为0.51。结论：这些发现表明，计划覆盖率的增加与Avahan计划覆盖的FSW之间的艾滋病毒流行率下降有关。我们的结果与其他用于评估Avahan的方法的结果进行了三角测量，表明该干预措施对印度南部的HIV流行产生了重大影响。

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