Assessing the Impact of a HIV Prevention Program Among Transgender People in Thailand Using Coarsened Exact Matching

Transcription

1 Evaluation 2013 October 16-19, 2013 Assessing the Impact of a HIV Prevention Program Among Transgender People in Thailand Using Coarsened Exact Matching Duangta Pawa Gary Mundy Yaowalak Jittakoat Sindh Ratchasi

2 PAGE 2 Introduction HIV prevalence among transgender women is 10% in Thailand* Transgender women face discrimination and stigma within their families or working life, with a significant of this population being involved in commercial sex work *Integrated Biological and Behavioral Surveillance among Men who have Sex with Men (MSM) in Thailand, 2011

3 PAGE 3 Sisters Program The purpose of the program is to promote safer sex among transgender women through peer education and drop in center activities in eastern Thailand

4 PAGE 4 Sisters Program Intervention Area: Eastern Thailand Pattaya, Sattahip and Sriracha in Chonburi Province, Thailand Sisters Intervention: Drop-in center Counseling Social services On-site HIV testing Peer-led interpersonal communication Home visit Sriracha Pattaya Sattahip Map of Chonburi Province, Thailand

5 PAGE 5 Research Objectives To be a baseline of behaviors; Condom use at last sex and consistent condom use with each partner type Consistent water-based lubricant use along with condom and HIV test Assess the effectiveness of Sister s model for reducing HIV risks among the transgender women in Thailand

6 PAGE 6 Methods Study Design: Cross Sectional Study Date of Data Collection: December 2011 Sampling: Data Collection Method: Study Questionnaire: Time-location Sampling Interview Scaled items presented on 6-point Likert scale, yes-no questions, and multiple choice questions

7 PAGE 7 Measurement Outcomes Condom use at last sex Consistent condom and water-based lubricant use in the past three months Receipt of an HIV test in the past six months. Program participation Receipt of any Sisters services in the past 12 months Attendance at the Sisters drop-in center (DIC) Interaction with a Sisters outreach worker

8 PAGE 8 Analysis Approach To improve causal inferences of estimates of program effectiveness, we used statistical matching as a quasi-experimental method to enable clear designation of a counterfactual Coarsened Exact Matching (CEM) A statistical technique used in observational studies to create treated cases (program participants) and control cases (nonparticipants), matched on observed factors that influenced selection into treatment

9 PAGE 9 Matching Technique Matching Variables Duration of residence in Pattaya: < 1 year, > 1 years Monthly income: <20,000THB/month, >20,000THB/month Occupation: work in entertainment venue, work as a freelance sex worker Number of transgender friends

10 RESULTS PAGE 10

11 PAGE 11 Condom Use 85% 73% 62% 55% 62% 36% Consistent condomconsistent condom use in the past 3 and water-based months lubricant use in past 3 months Consistent condom use in the past 3 months Consistent condom/waterbased lubricant use in the past 3 months Consistent condom use in the past 3 months Commercial partners Casual partners Regular partners Consistent condom/waterbased lubricant use in the past 3 months

12 PAGE 12 HIV Test Sisters Participation 72% 64% 55% 40% 17% HIV testing Received any Sisters service Visited Sisters drop-in center Received Sisters outreach Received Sisters home visit Program participation in the past 12 months

13 PAGE 13 Interaction with Sisters and Condom Use Matching Variables Duration of residence in Pattaya Monthly income Occupation Number of transgender friends Condom Use at Last Sex with Any Partner Indicator Odds ratio Lower CI 95% Upper P-value Received any Sisters services Interaction with a Sisters outreach worker

14 PAGE 14 Interaction with Sisters and Condom Use Matching Variables Duration of residence in Pattaya Monthly income Occupation Number of transgender friends Consistent Condom/Water-Based Lubricant Use in Past 3 Months Indicator Odds ratio Lower CI 95% Upper P-value Received any Sisters services Interaction with a Sisters outreach worker

15 PAGE 15 Interaction with Sisters and HIV testing Matching Variables Duration of residence in Pattaya Monthly income Occupation Number of transgender friends Received an HIV Test in the Past 6 Months Indicator Odds ratio Lower CI 95% Upper P-value Received any Sisters services Attendance at the Sisters drop-in center

16 PAGE 16 Limitation Recall bias in the outcomes Consistent condom and lubricant use Program participation Small sample size for transgender women that have casual and regular partner

17 PAGE 17 Discussion and Conclusion An HIV prevention program targeted to transgender women can address HIV-related risks The program influenced condom use at last sex and consistent condom use along with water-based lubricant in past 3 months Receipt of an HIV test was strongly related to participation in Sisters services CEM could be used to assess the effectiveness of the program when an experimental design was not an option with on-going program implementation and with a hard-to-reach population

18 PAGE 18 Questions? T H S T R E E T, N W S U I T E W A S H I N G T O N, D C P S I. O R G T W I T T E R P S I H E A LT H Y L I V E S B L O G : P S I H E A LT H Y L I V E S. C O M PSI