Effects of the Frontiers Prevention Project in Ecuador on sexual behaviours and sexually transmitted infections amongst men who have sex with men and female sex workers: challenges on evaluating complex interventions

Abstract

Effects of the Frontiers Prevention Project inIn this study, the authors evaluate the impact of the Frontiers Prevention Project (FPP), a community-based strategy for HIV prevention amongst female sex workers (FSW) and men who have sex with men (MSM) in Ecuador. The FPP impact evaluation methodology consisted of a community trial with randomised intervention/comparison assignment and pre-post surveys in six cities in Ecuador (2003Ecuador ( -2007. The results suggest prevention strategies involving key populations in their design and implementation can contribute to abating risk behaviours in Ecuador. However, the FPP experience also shows that implementing and evaluating large-scale HIV prevention programmes still present important challenges.

The impact of Community Mobilisation on HIV Prevention in Middle and Low Income Countries: A Systematic Review and Critique

“…The remaining twelve studies used various observational designs. In India, South and South East Asia, the RISHTA project [ 39 ], the Parivartan project [ 55 , 56 ], the Avahan project [ 57 – 62 ], the Frontiers Prevention Project (India) [ 63 ], a programme by the India HIV/AIDS Alliance [ 64 ], as well as a Sonagachi-replication [ 65 , 66 ] were implemented; in Latin America and the Caribbean, the Encontros project [ 67 ], the Princesinha project [ 68 ], the Frontiers Prevention Project (Ecuador) [ 69 ], a Sonagachi-inspired intervention [ 70 ], and a comparison between CM and CM plus policy changes [ 14 ] were carried out. Finally, the Carletonville project [ 71 ] was undertaken in Sub-Saharan Africa and a participatory intervention was implemented in Chengdu, China [ 72 ].…”

“…The boundaries of ‘community’ were conceptualised in three main ways by the selected studies. First, in contexts of concentrated HIV epidemics, interventions targeted groups most at risk: ten studies focused on sex workers [ 14 , 56 , 59 , 63 – 65 , 67 – 70 ], four on men who have sex with men (MSM) [ 57 , 63 , 69 , 72 ], and one study [ 39 ] focused on local heterosexual men whose high levels of alcohol consumption were found to be putting their sexual health at risk [ 73 ]. These communities were thus assumed to share a social identity, location and concrete practices (e.g.…”

“…The association between CMI and HIV prevalence was non-significant in 3 other states [ 60 – 62 ], although authors acknowledge that the prevalence in chronic diseases such as HIV could require long periods to be apparent. The Frontiers Prevention Project in Ecuador found no significant effects of the intervention on HIV seroprevalence among FSW and MSM [ 69 ].…”

“…Encouragingly, the Frontiers Prevention Project in Andhra Pradesh was associated with lower likelihood of syphilis and HSV-2 among both FSW and MSM [ 63 ]. A similar project in Ecuador rendered a significant impact in the reduction of likelihood of syphilis seroprevalence among MSM, while having a borderline effect of lower HSV-2 seroprevalence among FSW in the programme [ 69 ]; non-significant programme effects were observed on HSV-2 among MSM and syphilis among FSW [ 69 ]. Active participation in the Encontros study was related to a non-significantly lower probability of incident chlamydia and/or gonorrhoea [ 67 ], while the Carletonville project rendered a non-significant increase of syphilis, gonorrhoea and chlamydia among participant sex workers [ 71 ].…”

“… FSW: intervention associated with increase in condom use with regular partners ( p < 0.05) but no difference with last sexual client. NA Gutierrez et al [ 69 ] Frontiers Prevention Project Ecuador Cohort analytic Baseline and follow-up 4 years later. FSW & MSM in 6 cities N = 1727 MSM (1248 FPP, 479 non-FPP); 1526 FSW (752 FPP, 774 non-FPP) Baseline and follow-up.…”