1. Can community based HIV prevention have a positive effect on HIV testing behavior? Findings from a quasi- experimental study with female sex workers in Yangon and Mandalay T. Aung 1, S.T. Thein 1, N.E. Paw 1, T.R. Aung 1, G. Mundy 2 1 Population Services International/Myanmar, Strategic Information Department, Yangon, Myanmar 2 Population Services International, Bangkok, Thailand

2. Background PAGE 2

3. Myanmar and HIV  Concentrated epidemic 1 –within key-affected populations Female sex workers (FSW) Men who have sex with men (MSM) People who inject drugs (PWID) –general population prevalence <1%. 1 HIV Sentinel Sero-surveillence Survey 2011, National AIDS Programme, Ministry of Health

4. FSW and HIV in Myanmar  An estimated 9.4% of FSW in Myanmar are HIV positive 1  Prevalent risk behaviors –Inconsistent condom use –Low HIV testing rates 1 HIV Sentinel Sero-surveillence Survey 2011, National AIDS Programme, Ministry of Health

5. PSI/Myanmar TOP  'Targeted Outreach Program' (TOP) drop-in centers (DiC) –Providing health services to key affected populations (FSW and MSM) in 18 cities/towns in Myanmar –Community based approach using peers –Promoting HIV testing & condom use among FSW –Reached over 20,000 FSW with HIV prevention services in 2013

6. Methods PAGE 6

7. Study objectives 1.To measure the proportion of FSW who reported getting tested for HIV and receiving test results in the past 6 months 2.To assess the role of TOP DiC in promoting HIV testing

8. Study design  Cross-sectional survey using time-location cluster sampling  Study population – women who reported having sex with a man for money in the past 3 months in Yangon and Mandalay (N=702)  Study period – October to December 2013

9. Coarsened Exact Matching  Monotonic imbalance matching method designed to reduce imbalance between treatment and control groups in observational data 1  Used to match two groups –Those who had visited TOP DiC and –Those who never did  Two matching criteria –Location where clients were met (e.g., streets, brothels, bars, karaoke) –City of current residence (Yangon and Mandalay)  Analyzed using STATA version 11 1. Comparative effectiveness of matching methods for causal inference. http://gking.harvard.edu/files/gking/files/psparadox.pdf

10. Logistic Regression  Using CEM weights  Exposure Variable –TOP DiC Visits (those who had ever visited TOP DiC at least 4 months ago vs. those who never did)  Outcome variables –HIV testing within 6 months –STI check-up and treatment within 12 months  Adjusted covariates –Age, education, duration of sex work, presence of regular partner(s)

11. Results PAGE 11

12. HIV testing

13. STI within 12 months

14. Visits to TOP DiC  Ever visited TOP DiC – 38.3%  First visit more than four months prior to survey – 74.5% among those who visited

15.  Women who ever visited TOP DiC were four times more likely to get tested for HIV Influence of TOP DiC visits on HIV testing

16.  Women who ever visited TOP DiC were –3 times more likely to get STI checkup –8 times more likely to get STI Rx from qualified provider Influence of TOP DiC visits on STI Management

17. Conclusions  Targeted and community based HIV testing services through TOP centers work well  Should consider scaling-up –Wider coverage –Better access to harder to reach groups

18. Questions? 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I I M P A C T | B L O G. P S I i M P A C T. C O M PSI