title: Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China.
abstract: BACKGROUND
  Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence.
  
  
  METHODS
  From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type.
  
  
  RESULTS
  The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type.
  
  
  CONCLUSIONS
  Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners).
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. jane.liu@utoronto.ca.
authors.forename: Juan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. liviana.calzavara@utoronto.ca.
authors.forename: Liviana
authors.initials: L
authors.lastname: Calzavara
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. joshua.mendelsohn@utoronto.ca.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Mendelsohn
authors.affiliation: US Centres for Disease Control, Atlanta, GA, USA. aao0@cdc.gov.
authors.forename: Ann
authors.initials: A
authors.lastname: O'Leary
authors.affiliation: Shanghai Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
authors.forename: Laiyi
authors.initials: L
authors.lastname: Kang
authors.affiliation: Shanghai Centre for Disease Control and Prevention, Shanghai, China. qcpan@scdc.sh.cn.
authors.forename: Qichao
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. ted.myers@utoronto.ca.
authors.forename: Ted
authors.initials: T
authors.lastname: Myers
authors.affiliation: Shanghai Centre for Disease Control and Prevention, Shanghai, China. jinmaren@uicomp.uic.edu.|Centre for Outcomes Research, University of Illinois, College of Medicine, Peoria, IL, USA. jinmaren@uicomp.uic.edu.
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.affiliation: Songjiang District Centre for Disease Control and Prevention, Shanghai, China. chayanfen@sina.com.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Cha
authors.affiliation: Jiading District Centre for Disease Control and Prevention, Shanghai, China. stoneking100@sina.com.
authors.forename: Guozheng
authors.initials: G
authors.lastname: Shi
authors.affiliation: Baoshan District Centre for Disease Control and Prevention, Shanghai, China. 66786429@qq.com.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Minhang District Centre for Disease Control and Prevention, Shanghai, China. txhchm@163.com.
authors.forename: Xiuhong
authors.initials: X
authors.lastname: Tian
authors.affiliation: Luwan District Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
authors.forename: Huili
authors.initials: H
authors.lastname: Fan
authors.affiliation: Changning District Centre for Disease Control and Prevention, Shanghai, China. niyingjing@hotmail.com.
authors.forename: Yinqing
authors.initials: Y
authors.lastname: Ni
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. rs.remis@utoronto.ca.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Remis
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D012309:Risk-Taking; D021841:Safe Sex; D020377:Self Efficacy; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D057545:Social Stigma; D012959:Socioeconomic Factors; D055815:Young Adult