abstract: 'Introduction Female sex workers (FSW) who use drugs are a key population

  at risk of HIV in Kazakhstan, and face multiple structural barriers to

  HIV prevention. More research is needed on the role of structural

  interventions such as microfinance (MF) in reducing HIV risk. This paper

  describes the results of a cluster-randomized controlled trial to test

  the efficacy of a combination HIVRR + MF intervention in reducing

  biologically confirmed STIs and HIV risk behaviours.

  Methods This study took place from May 2015 to October 2018 in two

  cities in Kazakhstan. We screened 763 participants for eligibility and

  enrolled 354 FSW who use drugs. Participants were randomized in cohorts

  to receive either a four-session HIVRR intervention, or that same

  intervention plus 30 additional sessions of financial literacy training,

  vocational training and asset-building through a matched-savings

  programme. Repeated behavioural and biological assessments were

  conducted at baseline, 3-, 6- and 12-months post-intervention.

  Biological and behavioural primary outcomes included HIV/STI incidence,

  sexual risk behaviours and drug use risk behaviours, evaluated over the

  12-month period.

  Results Over the 12-month follow-up period, few differences in study

  outcomes were noted between arms. There was only one newly-detected HIV

  case, and study arms did not significantly differ on any STI incidence.

  At post-intervention assessments compared to baseline, both HIVRR and

  HIVRR + MF participants significantly reduced sexual and drug use risk

  behaviours, and showed improvements in financial outcomes, condom use

  attitudes and self-efficacy, social support, and access to medical care.

  In addition, HIVRR + MF participants showed a 72\% greater reduction in

  the number of unprotected sex acts with paying partners at the six-month

  assessment (IRR = IRR = 0.28, 95\% CI = 0.08, 0.92), and a 10\% greater

  reduction in the proportion of income from sex work at the three-month

  assessment (b = -0.10, 95\% CI = -0.17, -0.02) than HIVRR participants

  did. HIVRR + MF participants also showed significantly improved

  performance on financial self-efficacy compared to HIVRR over the

  12-month follow-up period.

  Conclusions Compared to a combination HIVRR + MF intervention, a robust

  HIVRR intervention alone may be sufficient to reduce sexual and drug

  risk behaviours among FSW who use drugs. There may be structural

  limitations to the promise of microfinance for HIV risk reduction among

  this population.'
affiliation: 'El-Bassel, N (Corresponding Author), Columbia Univ, Sch Social Work,
  Global Hlth Res Ctr Cent Asia, 1255 Amsterdam Ave, New York, NY 10027 USA.

  El-Bassel, Nabila; McCrimmon, Tara; Chang, Mingway; Witte, Susan S., Columbia Univ,
  Sch Social Work, Global Hlth Res Ctr Cent Asia, 1255 Amsterdam Ave, New York, NY
  10027 USA.

  Mergenova, Gaukhar; Terlikbayeva, Assel; Primbetova, Sholpan; Kuskulov, Azamat,
  Global Hlth Res Cent Asia, Alma Ata, Kazakhstan.

  Baiserkin, Bauyrzhan, Kazakh Sci Ctr Dermatol \& Infect Dis, Alma Ata, Kazakhstan.

  Denebayeva, Alfiya, Almaty City Ctr Prevent \& Control AIDS, Alma Ata, Kazakhstan.

  Kurmetova, Kulpan, Karaganda Oblast Ctr Prevent \& Control AIDS, Temirtau Branch,
  Temirtau, Kazakhstan.'
article-number: e25682
author: El-Bassel, Nabila and McCrimmon, Tara and Mergenova, Gaukhar and Chang, Mingway
  and Terlikbayeva, Assel and Primbetova, Sholpan and Kuskulov, Azamat and Baiserkin,
  Bauyrzhan and Denebayeva, Alfiya and Kurmetova, Kulpan and Witte, Susan S.
author-email: ne5@columbia.edu
author_list:
- family: El-Bassel
  given: Nabila
- family: McCrimmon
  given: Tara
- family: Mergenova
  given: Gaukhar
- family: Chang
  given: Mingway
- family: Terlikbayeva
  given: Assel
- family: Primbetova
  given: Sholpan
- family: Kuskulov
  given: Azamat
- family: Baiserkin
  given: Bauyrzhan
- family: Denebayeva
  given: Alfiya
- family: Kurmetova
  given: Kulpan
- family: Witte
  given: Susan S.
da: '2023-09-28'
doi: 10.1002/jia2.25682
eissn: 1758-2652
files: []
journal: JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
keywords: 'structural interventions; sex workers; drug use; HIV prevention;

  clinical trials'
keywords-plus: SUBSTANCE USE; INJECT DRUGS; WOMEN; PREVENTION; VIOLENCE; INCOME; SCALE
language: English
month: MAY
number: '5'
number-of-cited-references: '29'
papis_id: eef62caebf9728fb02de4abbfc8fd9d3
ref: Elbassel2021clusterrandomizedcon
researcherid-numbers: McCrimmon, Tara/GRR-3918-2022
times-cited: '4'
title: A cluster-randomized controlled trial of a combination HIV risk reduction and
  microfinance intervention for female sex workers who use drugs in Kazakhstan
type: article
unique-id: WOS:000655909900015
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '24'
web-of-science-categories: Immunology; Infectious Diseases
year: '2021'