Saysana Phanalasy Amy Gregowski Gary Mundy Phousiay Outhasith Rebecca Firestone Rob Gray

1. EVALUATING A HIV PREVENTION PROGRAM WITH TRANSGENDER WOMEN IN LAOS USING COARSENED EXACT MATCHING (CEM) SaysanaPhanalasy Amy Gregowski Gary Mundy PhousiayOuthasith Rebecca Firestone Rob Gray Evaluation 2013 October 16-19, 2013

2. Introduction Transgender women in Laos experience higher rates of HIV infection than the general population. Barriers, including stigma and discrimination, can make it difficult for Lao transgender (TG) women to access health services. There is a lack of evidence on effective programming currently. The study can inform our understanding of the effectiveness of HIV prevention programming for TG population in Laos.

3. “New Friends” Program • As part of the National HIV Program, PSI Laos developed the “New Friends” program to provide a CPS for Lao TG women and their sexual partners. • The program offers many services for TG women. TG woman are trained as Peer Educators and conduct IPC outreach activities for TG women and their partners to: • Encourage TG women to visit the DIC. • Encourage them to get tested for HIV and screened for STIs. • Increase the condom and water-based lube use behaviors. • Provide information on HIV/STI risk behaviors and places for testing and treatment services. • 2 DICs were establishedto provide below services: • Free rapid HIV testing and STI screening. • Referrals for subsidized STI treatment and referrals to HIV care and treatment.

5. Methods April-May 2012, chain referral sampling was used to recruit 417 TG women in Vientiane and Savannakhetto participate in a survey. Participants self-identified as TG and reported anal sex with a man in the past 6 months. Coarsened Exact Matching (CEM) and logistic regression analyses were used to test associations between program exposure and HIV/STI testing. Province, education level and size of social network were matched in CEM. CEM weights were used to adjust logistic regression models. Program participation was defined as “contact with peer outreach in the past 12 months or drop in center services in the past 3 months”.

6. Results

8. Estimates from multivariate logistic regression models predicting reported HIV testing among TG womenin Vientiane Capital and Savannakhet, Laos.

9. Estimates from multivariate logistic regression models predicting reported STI screening among TG women in Vientiane Capital and Savannakhet, Laos.

10. Limitations It was not possible to look at the condom use outcome due to a small sample reported sexually active in the past 1 month. Self-reported on HIV test and STI screening might be biased. The recall period used for some questions may also be a limitation. RDSAT should be considered to do when conducting the study in future.

11. Discussion and conclusion These data provide evidence that participation in program services was shown to increase both HIV testing and STI screening among Lao TG women. These results suggest that the New Friends project’s use of IPC outreach and DIC activities are effective health intervention for this key populationat risk.

12. Discussion and conclusion (Cont.) As a result, New Friends should continue to scale up to reach TG women through peer-led IPC outreach and DIC activities. In addition, the program should also continue working to improve other outcomes including HIV risk reduction behaviors i.e. consistent condom and water-based lubricant use with all sexual partner types.

13. Questions? PSI