Predictors of Retention among Men Attending STI Clinics in HIV Prevention Programs and Research: A Case Control Study in Pune, India

Retention is critical in HIV prevention programs and clinical research. We studied retention in the three modeled scenarios of primary prevention programs, cohort studies and clinical trials to identify predictors of retention.Men attending Sexually Transmitted Infection (STI) clinics (n = 10, 801) were followed in a cohort study spanning over a ten year period (1993-2002) in Pune, India. Using pre-set definitions, cases with optimal retention in prevention program (n = 1286), cohort study (n = 940) and clinical trial (n = 896) were identified from this cohort. Equal number of controls matched for age and period of enrollment were selected. A case control analysis using conditional logistic regression was performed. Being employed was a predictor of lower retention in all the three modeled scenarios. Presence of genital ulcer disease (GUD), history of commercial sex work and living away from the family were predictors of lower retention in primary prevention, cohort study and clinical trial models respectively. Alcohol consumption predicted lower retention in cohort study and clinical trial models. Married monogamous men were less likely to be retained in the primary prevention and cohort study models.Predicting potential drop-outs among the beneficiaries or research participants at entry point in the prevention programs and research respectively is possible. Suitable interventions might help in optimizing retention. Customized counseling to prepare the clients properly may help in their retention

Use of computer-assisted personal interviewing and information management system in a survey among hiv high-risk groups in India: Strengths, weaknesses, opportunities, and threats analysis

Objectives: In India, integrated biological and behavioral surveillance was carried out in 2014–2015 among high-risk key population as a part of second-generation HIV surveillance system. Computer-assisted personal interviewing and integrated information management system were used for the first time in this large national field based survey. We evaluated the strengths and weaknesses of technology use in this survey. Methods: Mixed methods comprising of the key informant's interviews and structured data collected from field interviewers were used to do the strengths, weaknesses, opportunities, and threats analysis with defined attributes. Results: Despite the challenges, the technology use in this survey was a huge success with respect to data coverage, response rates, real-time data, and acceptance by respondents. However, such techniques require more focus on the competency of human resource, training, and concurrent evaluation systems to get better data quality, time adherence, and effective use of technology. Conclusion: The recommendations resulted from this analysis will help for strategic management while designing such systems in field-based community surveys

Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India.

Sustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune, India.Among 14137 STI clinic attendees, 8360 HIV sero-negative men were enrolled in a cohort study. The changes in condom usage behavior were studied among 1284 men who returned for first scheduled quarterly follow up, 309 reported consistent condom use at the time of enrollment in the cohort. Data pertaining to heterosexual men practicing high risk behavior were analyzed to identify factors associated with change in condom use behavior using logistic regression model. Demographic, behavioral and biological factors observed to be associated with condom use were fitted in five Cox proportional hazards models to calculate hazard ratios and their 95% confidence intervals to identify independent predictors of failure to sustain condom use behavior.The univariate analysis showed that men who were 30 years or older in age (p = 0.002) and those who did not have contact female sex worker (FSW) were more likely to fail to sustain consistent condom use. However both these factors did not show significant association in multivariable analysis. Marital status and contact with Hijra (eunuch) in lifetime were associated with failure to change in their condom use behavior [AOR 0.33 (CI 0.13-0.82; p = 0.017)]. During the follow up of 2 years, 61 events (15.5 per 100 person years, 95% CI 12.3-19.5 years) of 'failure of condom use' were recorded despite counseling. Older age, contact with non CSW partner and presence of genital ulcer disease / discharge syndrome were significant predictors of failure to sustain condom use.Married monogamous older men, who report contact with sex worker and present with genital ulcer disease are at risk of failure to use condom after first exposure to voluntary HIV counseling and testing. This is a scenario of primary prevention program. Condom promotion and counseling needs to be reinforced through follow up counseling among this population

Profile of men identified as cases and controls in three respective scenarios of primary prevention, cohort study and clinical trial.

<p>CI: Confidence Interval.</p

Univariate analysis of Predictors of Retention in three modeled scenarios.

<p>Univariate analysis of Predictors of Retention in three modeled scenarios.</p

Predictors of retention in the modeled scenario of primary prevention (1a), cohort study (1b) and clinical trial (1c).

<p>Predictors of retention in the modeled scenario of primary prevention (1a), cohort study (1b) and clinical trial (1c).</p

Cox professional hazards analysis showing risk factors and hazards of inconsistent condom use during follow-up of two years among male patients attending STD clinics.

<p>^‡ Buddhist, Christian, Muslims and Others</p><p>^$$ Widowed, divorced and separated.</p><p>NA: Not applicable</p><p>* Significant at p value < 0.05,</p><p>** Significant at p value < 0.01</p><p>Cox professional hazards analysis showing risk factors and hazards of inconsistent condom use during follow-up of two years among male patients attending STD clinics.</p

Factors associated with failure to change from inconsistent condom use to ‘positive’ condom use behavior among male STD patients.

<p>^‡Others include unmarried, divorced, widower and separated.</p><p>GUD: Genital ulcer disease, GD: Genital discharge</p><p>* Significant at p value < 0.05,</p><p>** Significant at p value < 0.01</p><p>¹ Hijra is local term for éunuch</p><p>Factors associated with failure to change from inconsistent condom use to ‘positive’ condom use behavior among male STD patients.</p

Showing the study participant characteristics in step 1 and step 2 analysis

<p>Showing the study participant characteristics in step 1 and step 2 analysis</p