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

 

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.

 

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.
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.
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.
Test the feasibility of an intervention evaluation design to be used in a future study.

 

 

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).

 

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).

 

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);

 

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.