A community-based comprehensive intervention to reduce syphilis infection among low-fee female sex workers in China: a matched-pair, community-based randomized study

Abstract

BackgroundLow-fee female sex workers (FSWs) are at high risk of acquiring and spreading human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) in China. There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections. Thus, this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair, community-based randomized intervention trial carried out in 12 cities in three provinces in China.MethodsFour cities from Guangxi Zhuang Autonomous Region, four from Yunnan Province, and four from Hunan Province were paired and participants received either the intervention package (including condom promotion, HIV and syphilis testing, reimbursement for syphilis treatment costs, and free anti-retroviral therapy or the current standard of care. Venue-based, convenience sampling was used to recruit FSWs. A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months. Generalized linear mixed models (GLMM) were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.ResultsA total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up. GLMM results showed that syphilis infection was reduced by 49% in the intervention group compared to the current standard of care group (P = 0.0378, OR = 0.51, 95% CI: 0.27–0.96). FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old (P < 0.0001, OR = 2.38, 95% CI: 1.55–3.65). The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education (P < 0.05, OR = 0.43, 95% CI: 0.63–0.93).ConclusionsThis study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs. Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registrationCHiCTR-TRC-12002655.

Analysis of the Space and Time Distribution of Syphilis in Brazil: Cases of Acquired Syphilis From 2010-2018 and Congenital and Syphilis in Pregnant Women From 2001-2017

“…Furthermore, errors in antibiotic dosage have also been of concern. Other key factors, such as conjugal in delity, the absence of partners at prenatal appointments and reluctance in adhering to treatment protocols have also been reported by patients [27,31].…”

Sexual behaviour change following HIV testing services: a systematic review and meta‐analysis

“…Of the 32 studies [16][17][18][19][20][21][22][23][24][25][26][29][30][31][32][33][34][36][37][38][39][40]42,[44][45][46][47][48][49][50][51]91] that reported on condom use, 21 were individual-RCT and 11 were cluster-RCT, though two studies reported results from the same cluster-RCT [17,20]. The interventions included in these studies varied (Table 4).…”

“…The interventions included in these studies varied (Table 4). Seventeen studies examined enhanced counselling or education sessions compared to standard HTS [16,18,25,26,29,30,33,35,36,[38][39][40]42,45,49,50,91], two studies examined the distribution of HIV self-testing kits relative to standard HTS [31,32], two studies from the same cluster-RCT examined community-based HTS [17,20] along with two other studies [22,34], one study included couple HTS relative to standard HTS [37], one study examined counsellor-delivered home-based HTS versus clinic-based HTS [21] and one study examined abbreviated HTS compared to standard HTS [48].…”

“…Twelve studies reported on the number of total sex partners at follow-up [18,[22][23][24]29,32,39,[42][43][44]47,50]; five [24,29,39,43,44] were included in meta-analysis. There was an average of 0.28 fewer sex partners reported at follow-up among those receiving more versus less-intensive HTS (mean difference = À0.28; 95% CI = À3.66 to 3.10), though the finding was not significant (p = 0.87) and there was significant heterogeneity across studies (v 2 [df = 9] = 17605, p < .0001).…”

The prevalence and correlates of oral sex among low-tier female sex workers in Zhejiang province, China

“…According to China national HIV/AIDs sentinel surveillance report from 2011 to 2015, low-tier FSWs exhibited higher than middle-and high-tier FSWs in HIV and syphilis prevalence, with a HIV prevalence of 0.1-0.2% in middle-and high-tier FSWs versus 0.4-0.6% in low-tier FSWs, and a syphilis prevalence of 1.6-1.9% in middle-and high-tier FSWs versus 3.6-4.6% in low-tier FSWs. A high prevalence of HIV and syphilis was found among Chinese low-tier FSWs [12,13]. Therefore, low-tier FSWs play an important role in facilitating HIV and STI transmission, and their high mobility could also introduce HIV/STI transmission from one place to another.…”