title: An assessment of a large-scale HIV prevention programme for high-risk men who have sex with men and transgenders in Andhra Pradesh, India: using data from routine programme monitoring and repeated cross-sectional surveys.
abstract: OBJECTIVE
  To assess a large-scale intervention, the Avahan intervention, using an evaluation framework that included programme coverage, condom use and changes in sexually transmitted infection (STI) and HIV prevalence among high-risk men who have sex with men/transgender (HR-MSM/TG) in the state of Andhra Pradesh, India.
  
  
  METHODS
  Programme monitoring data and results from two rounds of cross-sectional integrated biological and behavioural assessment (IBBA) in 2006 (Round 1) and 2009 (Round 2) were used for current analysis.
  
  
  METHODS
  Programme monitoring data and cross-sectional surveys from Andhra Pradesh, India.
  
  
  METHODS
  Data from 1218 and 1203 participants in Rounds 1 and 2 of the IBBA, respectively, and field level programme monitoring data from the intervention districts.
  
  
  METHODS
  (1) Assess the reach of intervention in the HR-MSM/TG population; (2) evaluate the association between intervention and the intermediate outcomes (such as condom use and STIs) and (3) assess the association between HIV/STIs and the intervention.
  
  
  RESULTS
  By July 2008, the intervention contacted 83% of the estimated HR-MSM/TG population monthly and 16% were attending the STI clinic monthly. HR-MSM/TG exposed to the intervention were significantly more likely to use condom consistently with a regular male partner (adjusted OR 4.62, 95% CI 1.40 to 15.22). Consistent condom use with all types of male partners increased significantly in survey Round 2 compared with Round 1. The proportion of HR-MSM/TG who tested positive for HIV-1 antibodies was similar in both rounds (15.5% in Round 1 vs 17.3% in Round 2, p=0.52).
  
  
  CONCLUSIONS
  The Avahan intervention achieved a good population coverage, and delivered high-intensity peer and STI clinical services in Andhra Pradesh in the highly mobile target population of HR-MSM/TG; this also resulted in positive behavioural outcomes including increased condom use. However, the high prevalence of HIV in this group is an important public health priority.
authors.affiliation: M&E, FHI 360, New Delhi, India.
authors.forename: Prabuddhagopal
authors.initials: P
authors.lastname: Goswami
authors.forename: Hari Kumar
authors.initials: HK
authors.lastname: Rachakulla
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ramakrishnan
authors.forename: Shajan
authors.initials: S
authors.lastname: Mathew
authors.forename: Shreena
authors.initials: S
authors.lastname: Ramanathan
authors.forename: Bitra
authors.initials: B
authors.lastname: George
authors.forename: Rajatashuvra
authors.initials: R
authors.lastname: Adhikary
authors.forename: Venkaiah
authors.initials: V
authors.lastname: Kodavalla
authors.forename: Hemalatha
authors.initials: H
authors.lastname: Rajkumar
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Paranjape
authors.forename: G N V
authors.initials: GN
authors.lastname: Brahmam