Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data

Abstract Background The Avahan India AIDS Initiative was implemented to provide HIV prevention services to key populations including female sex workers (FSWs) who carry the burden of India’s concentrated HIV epidemic. Established in 2003 and handed over to the Indian government in 2009, the Initiati...

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Main Authors: Renay Weiner, Micah Fineberg, Bridget Dube, Prabuddhagopal Goswami, Shajan Mathew, Gina Dallabetta, Saul Johnson
Format: Article
Language:English
Published: BMC 2018-07-01
Series:BMC Public Health
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12889-018-5842-6
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spelling doaj-7698c81def2f47fdaccb35520c544a962020-11-25T02:22:46ZengBMCBMC Public Health1471-24582018-07-0118111010.1186/s12889-018-5842-6Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan dataRenay Weiner0Micah Fineberg1Bridget Dube2Prabuddhagopal Goswami3Shajan Mathew4Gina Dallabetta5Saul Johnson6School of Public Health, University of the WitwatersrandGenesis AnalyticsGenesis AnalyticsFHI 360FHI 360Bill and Melinda Gates FoundationGenesis AnalyticsAbstract Background The Avahan India AIDS Initiative was implemented to provide HIV prevention services to key populations including female sex workers (FSWs) who carry the burden of India’s concentrated HIV epidemic. Established in 2003 and handed over to the Indian government in 2009, the Initiative included peer-led outreach education, condom promotion and distribution and STI treatment. This study aimed to determine if HIV prevention cascades could be generated using routine monitoring and evaluation data from the Avahan program and to assess their value in identifying and responding to program gaps for FSWs. Methods Two data sources were used namely the Integrated Behavioural and Biological Assessment reports and the Centralized Management Information System dataset. Indicators selected for the cascades were: FSWs at risk, belief that HIV can be prevented, condom access and consistent condom use with an occasional partner. Six districts were selected and stratified by HIV prevalence at baseline and two cascades were generated per district reflecting changes over time. Results Consistent condom use with occasional partners in this population increased in all six districts during program implementation, with statistically significant increases in four of the six. No patterns in the cascades were detected according to HIV prevalence either at baseline (2005) or at follow-up (2009). Cascades were able to identify key programmatic bottlenecks at baseline that could assist with focusing program efforts and direct resources at district levels. In some districts the belief that HIV could not be prevented contributed to inconsistent condom use, while in others, low levels of condom access were a more important barrier to consistent condom use. Conclusion This HIV prevention cascade analysis among FSWs in India suggests that cascades could assist in identifying program gaps, focus intervention efforts and monitor their effect. However, cascades cannot replace a detailed understanding of the multiple factors at individual, community and structural levels that lead to consistent condom use in this key population. Careful indicator selection coupled with innovative data collection methods will be required. Pilot projects are proposed to formally evaluate the value of HIV prevention cascades at district level.http://link.springer.com/article/10.1186/s12889-018-5842-6Female sex workersIndiaAvahanHIV prevention cascadesCondom
collection DOAJ
language English
format Article
sources DOAJ
author Renay Weiner
Micah Fineberg
Bridget Dube
Prabuddhagopal Goswami
Shajan Mathew
Gina Dallabetta
Saul Johnson
spellingShingle Renay Weiner
Micah Fineberg
Bridget Dube
Prabuddhagopal Goswami
Shajan Mathew
Gina Dallabetta
Saul Johnson
Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
BMC Public Health
Female sex workers
India
Avahan
HIV prevention cascades
Condom
author_facet Renay Weiner
Micah Fineberg
Bridget Dube
Prabuddhagopal Goswami
Shajan Mathew
Gina Dallabetta
Saul Johnson
author_sort Renay Weiner
title Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
title_short Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
title_full Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
title_fullStr Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
title_full_unstemmed Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
title_sort using a cascade approach to assess condom uptake in female sex workers in india: a review of the avahan data
publisher BMC
series BMC Public Health
issn 1471-2458
publishDate 2018-07-01
description Abstract Background The Avahan India AIDS Initiative was implemented to provide HIV prevention services to key populations including female sex workers (FSWs) who carry the burden of India’s concentrated HIV epidemic. Established in 2003 and handed over to the Indian government in 2009, the Initiative included peer-led outreach education, condom promotion and distribution and STI treatment. This study aimed to determine if HIV prevention cascades could be generated using routine monitoring and evaluation data from the Avahan program and to assess their value in identifying and responding to program gaps for FSWs. Methods Two data sources were used namely the Integrated Behavioural and Biological Assessment reports and the Centralized Management Information System dataset. Indicators selected for the cascades were: FSWs at risk, belief that HIV can be prevented, condom access and consistent condom use with an occasional partner. Six districts were selected and stratified by HIV prevalence at baseline and two cascades were generated per district reflecting changes over time. Results Consistent condom use with occasional partners in this population increased in all six districts during program implementation, with statistically significant increases in four of the six. No patterns in the cascades were detected according to HIV prevalence either at baseline (2005) or at follow-up (2009). Cascades were able to identify key programmatic bottlenecks at baseline that could assist with focusing program efforts and direct resources at district levels. In some districts the belief that HIV could not be prevented contributed to inconsistent condom use, while in others, low levels of condom access were a more important barrier to consistent condom use. Conclusion This HIV prevention cascade analysis among FSWs in India suggests that cascades could assist in identifying program gaps, focus intervention efforts and monitor their effect. However, cascades cannot replace a detailed understanding of the multiple factors at individual, community and structural levels that lead to consistent condom use in this key population. Careful indicator selection coupled with innovative data collection methods will be required. Pilot projects are proposed to formally evaluate the value of HIV prevention cascades at district level.
topic Female sex workers
India
Avahan
HIV prevention cascades
Condom
url http://link.springer.com/article/10.1186/s12889-018-5842-6
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