title: Programme coverage, condom use and STI treatment among FSWs in a large-scale HIV prevention programme: results from cross-sectional surveys in 22 districts in southern India.
abstract: OBJECTIVE
  This paper evaluates Avahan programme's coverage of female sex workers (FSWs), focus on high-risk FSWs and intermediate outcomes.
  
  
  METHODS
  First round of cross-sectional survey data, Integrated Behavioral and Biological Assessments (IBBA), conducted in 22 districts, were aggregated into district categories: Solo, where Avahan was the sole service provider covering all FSWs and Major or Minor where Avahan was not the sole provider, but intended coverage was >50% or <or= 50% of FSWs respectively. Multivariate logistic regression was applied to compare exposure by district categories, vulnerability factors and intermediate outcomes associated with exposure.
  
  
  RESULTS
  Reported exposure, evaluated on basis of having received any of three core services, was higher in Solo (75%) compared with Minor (66%) districts. Logistic regression showed that FSWs in solo districts were more likely to be exposed (adjusted odds ratio (AOR)=1.5; 95% CI 1.20 to 1.86) compared with FSWs in Minor districts. Multivariate analysis in Solo districts revealed that FSW with >or=15 clients in the past week had a higher chance of being exposed to core services (AOR=1.56; 95% CI 1.03 to 2.35). Exposure to the three services in Solo Avahan districts was significantly associated with correct knowledge on condom use (AOR=1.36; 95% CI 1.05 to 1.78), consistent condom use with occasional clients (AOR=3.17; 95% CI 2.17 to 4.63) and regular clients (AOR=2.47; 95% CI 1.86 to 3.28) and STI treatment-seeking behaviour (AOR=3.00; 95% CI 1.94 to 4.65).
  
  
  CONCLUSIONS
  Higher coverage of FSWs was achieved in districts where Avahan was the only intervention compared with districts having multiple and longstanding non-Avahan programmes. Exposure in Solo districts was associated with intermediate outcomes; this need to be further evaluated in comparison with non Avahan areas and substantiated through data from next IBBA.
authors.affiliation: Family Health International, New Delhi, India. lramakrishnan@fhiindia.org
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ramakrishnan
authors.forename: Abhishek
authors.initials: A
authors.lastname: Gautam
authors.forename: Prabuddhagopal
authors.initials: P
authors.lastname: Goswami
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Kallam
authors.forename: Rajatashuvra
authors.initials: R
authors.lastname: Adhikary
authors.forename: Mandar K
authors.initials: MK
authors.lastname: Mainkar
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: Guy
authors.initials: G
authors.lastname: Morineau
authors.forename: Bitra
authors.initials: B
authors.lastname: George
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Paranjape
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015397:Program Evaluation; D021841:Safe Sex / Q000706:statistics & numerical data*; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000628:therapy; D012959:Socioeconomic Factors; D055815:Young Adult