title: Effectiveness of an Integrated Community- and Clinic-Based Intervention on HIV Testing, HIV Knowledge, and Sexual Risk Behavior of Young Men Who Have Sex With Men in Myanmar.
abstract: OBJECTIVE
  Young men who have sex with men (YMSM) in Myanmar are disproportionately affected by HIV, with prevalence five times that of the general population. The Link Up project implemented an intervention using peer education and outreach providing education and counseling on health seeking around sexually transmitted infections and reproductive health, combined with focused clinic capacity building to improve the sexual and reproductive health of YMSM. This study aimed to evaluate the effectiveness and acceptability of the intervention.
  
  
  METHODS
  Using a mixed-methods approach, and employing a quasi-experimental design, we conducted two quantitative repeat cross-sectional surveys in purposively selected control (no intervention) and intervention townships, before and after implementation of the Link Up intervention. Respondent-driven sampling was used to recruit YMSM aged 15-24 years, and study participants were administered a structured questionnaire assessing intervention exposure, health service access, knowledge of HIV, and sexual risk behavior. Focus group discussions were held to elicit perspectives on the use and acceptability of the health services and peer outreach.
  
  
  RESULTS
  At baseline, 314 YMSM were recruited in the intervention townships and 309 YMSM in the control townships. At end line, 267 (intervention) and 318 (control) YMSM were recruited. Coverage of the program was relatively low, with one-third of participants in the intervention townships having heard of the Link Up program by the end line. Comparing changes between baseline and end line, a greater proportion of HIV-negative or unknown status YMSM accessed HIV testing in the past 3 months in intervention townships (from 45.0% to 57.1%) compared with those in control townships (remained at 29.0%); however, this difference in the effect over time was not statistically significant in multivariate modeling (adjusted odds ratio: 1.45; 95% confidence interval: .66-3.17). Qualitative findings showed that the intervention was acceptable to YMSM.
  
  
  CONCLUSIONS
  Overall, the intervention was perceived as acceptable. Although not statistically significant, results showed some trends toward improvements among YMSM in accessing HIV testing services and HIV-related knowledge. The modest coverage and short time frame of the evaluation likely limits the ability for any significant behavioral improvements.
authors.affiliation: Burnet Institute, Yangon, Myanmar; Institute for Global Health, Yangon, Myanmar; University of Maryland, Baltimore, Maryland.
authors.forename: Poe Poe
authors.initials: PP
authors.lastname: Aung
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Population Council, Phnom Penh, Cambodia. Electronic address: abajracharya@popcouncil.org.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bajracharya
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Naanki
authors.initials: N
authors.lastname: Pasricha
authors.affiliation: Burnet Institute, Yangon, Myanmar; Institute for Global Health, Yangon, Myanmar; University of Maryland, Baltimore, Maryland.
authors.forename: Zaw Win
authors.initials: ZW
authors.lastname: Thein
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Agius
authors.affiliation: Burnet Institute, Yangon, Myanmar.
authors.forename: Than Tun
authors.initials: TT
authors.lastname: Sein
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Willenberg
authors.affiliation: International HIV/AIDS Alliance, Yangon, Myanmar; Volunteer Service Overseas, Yangon, Myanmar.
authors.forename: Ei Mon
authors.initials: EM
authors.lastname: Soe
authors.affiliation: Marie Stopes International, Yangon, Myanmar.
authors.forename: Ne Tun
authors.initials: NT
authors.lastname: Zaw
authors.affiliation: Population Council, Washington, DC.
authors.forename: Waimar
authors.initials: W
authors.lastname: Tun
authors.affiliation: Population Council, Washington, DC.
authors.forename: Eileen
authors.initials: E
authors.lastname: Yam
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D002052:Myanmar; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV; Health seeking; Men who have sex with men; Myanmar; Peer education; Quasi-experimental study; Sexual risk behavior; Young people