A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial
Abstract Background Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found t...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Women's Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12905-019-0807-1 |
| _version_ | 1818917369410486272 |
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| author | Fred M. Ssewamala Ozge Sensoy Bahar Yesim Tozan Proscovia Nabunya Larissa Jennings Mayo-Wilson Joshua Kiyingi Joseph Kagaayi Scarlett Bellamy Mary M. McKay Susan S. Witte |
| author_facet | Fred M. Ssewamala Ozge Sensoy Bahar Yesim Tozan Proscovia Nabunya Larissa Jennings Mayo-Wilson Joshua Kiyingi Joseph Kagaayi Scarlett Bellamy Mary M. McKay Susan S. Witte |
| author_sort | Fred M. Ssewamala |
| collection | DOAJ |
| description | Abstract Background Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. Methods This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. Discussion When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention’s efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. Trial registration ClinicalTrials.gov, ID: NCT03583541. |
| first_indexed | 2024-12-20T00:32:58Z |
| format | Article |
| id | doaj.art-aa27ee577617467caf84eb34776f9fdf |
| institution | Directory Open Access Journal |
| issn | 1472-6874 |
| language | English |
| last_indexed | 2024-12-20T00:32:58Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Women's Health |
| spelling | doaj.art-aa27ee577617467caf84eb34776f9fdf2022-12-21T19:59:53ZengBMCBMC Women's Health1472-68742019-08-0119112110.1186/s12905-019-0807-1A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trialFred M. Ssewamala0Ozge Sensoy Bahar1Yesim Tozan2Proscovia Nabunya3Larissa Jennings Mayo-Wilson4Joshua Kiyingi5Joseph Kagaayi6Scarlett Bellamy7Mary M. McKay8Susan S. Witte9Brown School, Washington University in St. LouisBrown School, Washington University in St. LouisCollege of Global Public Health, New York UniversityBrown School, Washington University in St. LouisIndiana University School of Public HealthInternational Center for Child Health and DevelopmentRakai Health Sciences ProgramDrexel UniversityBrown School, Washington University in St. LouisColumbia University School of Social WorkAbstract Background Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. Methods This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. Discussion When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention’s efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. Trial registration ClinicalTrials.gov, ID: NCT03583541.http://link.springer.com/article/10.1186/s12905-019-0807-1Women engaged in sex workEconomic empowermentSub-Saharan AfricaUgandaHIV/AIDS |
| spellingShingle | Fred M. Ssewamala Ozge Sensoy Bahar Yesim Tozan Proscovia Nabunya Larissa Jennings Mayo-Wilson Joshua Kiyingi Joseph Kagaayi Scarlett Bellamy Mary M. McKay Susan S. Witte A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial BMC Women's Health Women engaged in sex work Economic empowerment Sub-Saharan Africa Uganda HIV/AIDS |
| title | A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial |
| title_full | A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial |
| title_fullStr | A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial |
| title_full_unstemmed | A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial |
| title_short | A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial |
| title_sort | combination intervention addressing sexual risk taking behaviors among vulnerable women in uganda study protocol for a cluster randomized clinical trial |
| topic | Women engaged in sex work Economic empowerment Sub-Saharan Africa Uganda HIV/AIDS |
| url | http://link.springer.com/article/10.1186/s12905-019-0807-1 |
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