Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar.
OBJECTIVE
To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion.


METHODS
In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion


METHODS
peer education only, or peer education supplemented with individual clinic-based counselling. Participants were followed for 12 months. Every 2 months they made clinic visits, where they were interviewed on condom use. Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhoea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit.


RESULTS
There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups.


CONCLUSIONS
This study found little evidence for gains from more thorough clinical counselling on male and female condom use. These findings suggest that less clinically intensive interventions such as peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion.
Hoke
Theresa H
TH
Family Health International, PO Box 13950, Research Triangle Park, North Carolina 27709, USA. thatzell@fhi.org
Feldblum
Paul J
PJ
Damme
Kathleen Van
KV
Nasution
Marlina D
MD
Grey
Thomas W
TW
Wong
Emelita L
EL
Ralimamonjy
Louisette
L
Raharimalala
Leonardine
L
Rasamindrakotroka
Andry
A
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D019111:Single-Use Internal Condom / Q000706:statistics & numerical data; D003376:Counseling / Q000379:methods*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D010379:Peer Group; D015995:Prevalence; D015397:Program Evaluation; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D040241:Social Marketing; D016896:Treatment Outcome