title: Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation.
abstract: BACKGROUND
  Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program's effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks.
  
  
  METHODS
  PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage.
  
  
  RESULTS
  Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10).
  
  
  CONCLUSIONS
  PASMO's strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.
authors.affiliation: Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC 20036, USA. rfirestone@psi.org.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Firestone
authors.forename: Jorge
authors.initials: J
authors.lastname: Rivas
authors.forename: Susana
authors.initials: S
authors.lastname: Lungo
authors.forename: Alejandra
authors.initials: A
authors.lastname: Cabrera
authors.forename: Susan
authors.initials: S
authors.lastname: Ruether
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wheeler
authors.forename: Lung
authors.initials: L
authors.lastname: Vu
mesh_terms: D000293:Adolescent; D000328:Adult; D002489:Central America / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003364:Costa Rica / Q000453:epidemiology; D004544:El Salvador / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D009527:Nicaragua / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000145:classification; D011795:Surveys and Questionnaires