EVALUATING A HIV PREVENTION PROGRAM WITH TRANSGENDER WOMEN

IN LAOS USING COARSENED EXACT MATCHING (CEM)

Saysana PhanalasyAmy GregowskiGary MundyPhousiay OuthasithRebecca FirestoneRob Gray

Evaluation 2013

October 16-19, 2013

Transgender women in Laos experience higher rates of HIV infection than the general population.

Barriers, including stigma and discrimination, can make it difficult for Lao transgender (TG) women to access health services.

There is a lack of evidence on effective programming currently.

The study can inform our understanding of the effectiveness of HIV prevention programming for TG population in Laos.

Introduction

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As part of the National HIV Program, PSI Laos developed the “New Friends” program to provide a CPS for Lao TG women and their sexual partners.

The program offers many services for TG women. TG woman are trained as Peer Educators and conduct IPC outreach activities for TG women and their partners to:

– Encourage TG women to visit the DIC.– Encourage them to get tested for HIV and screened

for STIs.– Increase the condom and water-based lube use

behaviors.– Provide information on HIV/STI risk behaviors and

places for testing and treatment services.

2 DICs were established to provide below services:– Free rapid HIV testing and STI screening. – Referrals for subsidized STI treatment and referrals to

HIV care and treatment.

“New Friends” Program

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April-May 2012, chain referral sampling was used to recruit 417 TG women in Vientiane and Savannakhet to participate in a survey.

Participants self-identified as TG and reported anal sex with a man in the past 6 months.

Coarsened Exact Matching (CEM) and logistic regression analyses were used to test associations between program exposure and HIV/STI testing.

Province, education level and size of social network were matched in CEM. CEM weights were used to adjust logistic regression models.

Program participation was defined as “contact with peer outreach in the past 12 months or drop in center services in the past 3 months”.

Methods

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Results

Behavioral and program exposure in matched sample (n=411) among TG women in Vientiane and Savannakhet, Laos

Factors %

Reported testing for HIV in the past 12 months 52.3

Reported screening for STI in the past 12 months 34.1

Exposed New Friends peer outreach in the past 12 months or drop in center services in the past 3 months

70.8

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Full Sample (n=417) Matched Sample (n=411)

Predictors Adjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value

Program participation

No 1 1

Yes 13.1 (7.28-23.6) <0.001 9.06 (5.27-15.58) <0.001

Age

15-22 1 1

23-35 0.59 (0.37-0.96) 0.036 0.55 (0.34-0.88) 0.014

Number of sex partners in the past 12 months

1-5 1 1

6 or more 1.7 (1.02-2.86) 0.041 1.85 (1.11-3.07) 0.018

Sold sex in the past 12 months

No 1 1

Yes 1.7 (0.98-2.94) 0.056 1.81 (1.06-3.10) 0.031

Estimates from multivariate logistic regression models predicting reported HIV testing among TG women in Vientiane Capital and Savannakhet, Laos.

Full Sample (n=417) Matched Sample (n=411)

Predictors Adjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value

Program participation

No 1 1

Yes 16.39

(6.92-38.85)

<0.001 16.01

(6.86-37.38)

<0.001

Sold sex in the past 12 months

No 1 1

Yes 1.62

(0.96-2.73)

0.069 1.69

(1.00-2.85)

0.048

Estimates from multivariate logistic regression models predicting reported STI screening amongTG women in Vientiane Capital and Savannakhet, Laos.

It was not possible to look at the condom use outcome due to a small sample reported sexually active in the past 1 month.

Self-reported on HIV test and STI screening might be biased.

The recall period used for some questions may also be a limitation.

RDSAT should be considered to do when conducting the study in future.

Limitations

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Discussion and conclusion

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These data provide evidence that participation in

program services was shown to increase both HIV

testing and STI screening among Lao TG women.

These results suggest that the New Friends project’s

use of IPC outreach and DIC activities are effective

health intervention for this key population at risk.

Discussion and conclusion (Cont.)

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As a result, New Friends should continue to scale up to

reach TG women through peer-led IPC outreach and

DIC activities.

In addition, the program should also continue working to

improve other outcomes including HIV risk reduction

behaviors i.e. consistent condom and water-based

lubricant use with all sexual partner types.

Questions?

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