- To develop a multi-level HIV risk-reduction intervention targeting sex workers and their clients at entertainment venues (bars/night clubs) in Mombasa, Kenya and test its feasibility and acceptability, as well as the feasibility of an intervention evaluation design to be used in a future larger study.
- Understand the socio-cultural context of risk behavior, beliefs/understandings of HIV and risk; barriers to and facilitators of risk-reduction; and responses to intervention messages among male and female sex workers (MSWs/FSWs) and their clients.
- In collaboration with local key informants, design a venue-based multi-level risk-reduction intervention tailored to the local context and informed by theory and prior experiences.
- Test the intervention package at 3 selected venues for feasibility, acceptability, as well as participant level of exposure and intervention contamination at 3 control sites.
- Test the feasibility of an intervention evaluation design to be used in a future study.
Phase 1. Formative Work:
- Selection of the 6 study venues and establishment of a venue managers’ association;
- Conduct in-depth interviews with MSWs, FSWs, and their male clients (N=75).
Phase 2. Intervention Development:
- Develop culturally-relevant HIV/STI prevention messages, materials, and delivery modes, based on the formative data, that will be incorporated into a multi-level intervention that will comprise of a combination of SW-led peer HIV prevention, sensitization of law enforcement and moonlight HTC/STI clinics;
- Recruit, train and monitor SW Peer Educators;
- Conduct 4 focus group discussions with FSWs and MSWs to refine the intervention (N=32).
Phase 3. Intervention Pilot and Evaluation:
- Pilot the intervention at 3 randomly assigned venues;
- Collect process measures through SW peer educators’ field logs, structured observation checklists and brief anonymous exit interviews among MSW, FSW and clients visiting the intervention venues (N=432);
- Conduct pre- and post-intervention cross-sectional surveys to determine outcome parameters for a future trial as well as assess SWs’ and clients’ intervention exposure and extent of contamination between intervention and control venues;
- Compare alternative ways of measuring condom use (self-report via interview and text messaging, biomarkers) so as to determine most relevant measures for use in a larger trial
- Test the validity of the use of the SPERM HY-LITER kit for the detection of semen in the rectum on a sample of female and male sex workers (N=60);
- A multi-level HIV risk-reduction intervention targeting sex workers and their clients at entertainment venues is developed that is tailored to the local context and is informed by formative research, theory and prior experiences.
- The intervention is successfully piloted at randomly selected entertainment venues during a period of 6 months.
- The intervention is tested for its feasibility, acceptability and level of beneficiary exposure.
- The feasibility of an intervention evaluation design to be used in a future study is tested, including the identification of appropriate outcome parameters and measures for condom use, and the degree of intervention contamination at control sites.
- The feasibility of longitudinal cohorts of FSW, MSW, and clients in a future trial is assessed.