title: Two cross-sectional studies in south India assessing the effect of an HIV prevention programme for female sex workers on reducing syphilis among their clients.
abstract: OBJECTIVE
  To assess the impact of the Avahan HIV prevention programme for female sex workers (FSWs) in south India on reducing syphilis prevalence among their clients, by comparing rates of syphilis over time as reported in two large-scale surveys of FSWs' clients.
  
  
  METHODS
  A random-effect multilevel logistic regression analysis was performed using syphilis as the dependent variable, with individual independent variables (from the two survey rounds) at level 1 and the district-level programme (from the Avahan computerised monitoring and information system) and contextual variables (from Indian government datasets) at level 2. Programme variables included their 2006 value and their difference in value between 2008 and 2006, as well as the interaction between the latter and the study round. The analysis also controlled for baseline syphilis prevalence and its interaction with the study round.
  
  
  RESULTS
  Syphilis decreased significantly among FSWs' clients, from 4.8% (round 1) to 2.6% (round 2), p<0.001. The OR of the interaction term between the difference in programme coverage of FSWs and the round was 0.98 (p=0.023), suggesting that increased coverage was associated with a reduced incidence of syphilis.
  
  
  CONCLUSIONS
  This study suggests that the Avahan intervention programme among FSWs reduced syphilis rates among their clients.
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India Karnataka Health Promotion Trust, Bangalore, Karnataka, India.
authors.forename: Subramanian Potty
authors.initials: SP
authors.lastname: Rajaram
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Banandur
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India St. John's Research Institute, Bangalore, Karnataka, India.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Thammattoor
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India St. John's Research Institute, Bangalore, Karnataka, India.
authors.forename: Tinku
authors.initials: T
authors.lastname: Thomas
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Mandar K
authors.initials: MK
authors.lastname: Mainkar
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Paranjape
authors.affiliation: FHI 360, Washington, DC, USA.
authors.forename: Rajatashurva
authors.initials: R
authors.lastname: Adhikary
authors.affiliation: URESP, Centre de recherche du CHU de Québec, Québec, Canada Département de mathématiques et statistique, Université Laval, Québec, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Duchesne
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.affiliation: Karnataka Health Promotion Trust, Bangalore, Karnataka, India.
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.affiliation: CHARME-India II Project, Bangalore, Karnataka, India Karnataka Health Promotion Trust, Bangalore, Karnataka, India Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: URESP, Centre de recherche du CHU de Québec, Québec, Canada Département de mathématiques et statistique, Université Laval, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D055361:Multilevel Analysis; D016017:Odds Ratio; D015995:Prevalence; D021841:Safe Sex / Q000706:statistics & numerical data; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult