HIV prevention interventions targeting sex workers and their clients in Kenya (BORESHA)

OBJECTIVES

Overall objective:

  • To develop a multi-level HIV risk-reduction intervention targeting sex workers and their clients at entertainment venues (bars/night clubs) in Mombasa, Kenya and test its feasibility and acceptability, as well as the feasibility of an intervention evaluation design to be used in a future larger study.

Specific objectives:

  1. Understand the socio-cultural context of risk behavior, beliefs/understandings of HIV and risk; barriers to and facilitators of risk-reduction; and responses to intervention messages among male and female sex workers (MSWs/FSWs) and their clients.
  2. In collaboration with local key informants, design a venue-based multi-level risk-reduction intervention tailored to the local context and informed by theory and prior experiences.
  3. Test the intervention package at 3 selected venues for feasibility, acceptability, as well as participant level of exposure and intervention contamination at 3 control sites.
  4. Test the feasibility of an intervention evaluation design to be used in a future study.

ACTIVITIES

Phase 1.  Formative Work:

  • Selection of the 6 study venues and establishment of a venue managers’ association;
  • Conduct in-depth interviews with MSWs, FSWs, and their male clients (N=75).

Phase 2.  Intervention Development:

  • Develop culturally-relevant HIV/STI prevention messages, materials, and delivery modes, based on the formative data, that will be incorporated into a multi-level intervention that will comprise of a combination of SW-led peer HIV prevention, sensitization of law enforcement and moonlight HTC/STI clinics;
  • Recruit, train and monitor SW Peer Educators;
  • Conduct 4 focus group discussions with FSWs and MSWs to refine the intervention (N=32).

Phase 3.  Intervention Pilot and Evaluation:

  • Pilot the intervention at 3 randomly assigned venues;
  • Collect process measures through SW peer educators’ field logs, structured observation checklists and brief anonymous exit interviews among MSW, FSW and clients visiting the intervention venues (N=432);
  • Conduct pre- and post-intervention cross-sectional surveys to determine outcome parameters for a future trial as well as assess SWs’ and clients’ intervention exposure and extent of contamination between intervention and control venues;
  • Compare alternative ways of measuring condom use (self-report via interview and text messaging, biomarkers) so as to determine most relevant measures for use in a larger trial
  • Test the validity of the use of the SPERM HY-LITER kit for the detection of semen in the rectum on a sample of female and male sex workers (N=60);

EXPECTED RESULTS

  • A multi-level HIV risk-reduction intervention targeting sex workers and their clients at entertainment venues is developed that is tailored to the local context and is informed by formative research, theory and prior experiences.
  • The intervention is successfully piloted at randomly selected entertainment venues during a period of 6 months.
  • The intervention is tested for its feasibility, acceptability and level of beneficiary exposure.
  • The feasibility of an intervention evaluation design to be used in a future study is tested, including the identification of appropriate outcome parameters and measures for condom use, and the degree of intervention contamination at control sites.
  • The feasibility of longitudinal cohorts of FSW, MSW, and clients in a future trial is assessed.
Undefined
Project categories: 
Geography: 
Funding agencies: 
Coordinator: 
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (lead)
Partners: 
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (lead); International Centre for Reproductive Health-Kenya; Stat-Gent CRESCENDO of the University Ghent
Project status: 
Ongoing
Period: 
01/04/2014 - 31/03/2017
Ends on: 
Friday, March 31, 2017