jHASE research article freely available online oa open access ☼ jHASE web site: www.ieph.org/hase/jhase.htm Page 1 of 12 (page numbers not for citation purposes) jHASE 2011, 3(1):1 [Volume 3(Issue 1), Article 1] Using surveillance data to evaluate a large-scale HIV highway intervention targeting female sex workers in the Terai region of Nepal Dimitri Prybylski 1 , Laxmi B Acharya 2 , Sidhartha M Tuladhar 3 , Niranjan Dhungel 3 , Bharat R Gautam 2 , Jacqueline McPherson 2 , Vijaya L Gurbacharyta 4 , Stephen Mills 5,6 Author affiliations: 1 US Centers for Disease Control and Prevention - Global AIDS Program Asia Regional Office, Thailand (affiliation at time of submission: FHI, Asia-Pacific Regional Office, Thailand); 2 FHI, Nepal Country Office; 3 New ERA, Nepal; 4 STD/AIDS Counseling and Testing Services, Nepal; 5 FHI, Vietnam Country Office and 6 School of Public Health, University of North Carolina, USA. Email: DP(* Corresponding author): dimitrip@th.cdc.gov; LBA: lacharya@fhi.org.np; SMT: siddhartha@newera.wlink.com.np; ND: niranjan@newera.wlink.com.np; BRG: gautam@fhi.org.np; JM: jackie@fhi.org.np; VLG: dprybylski@msn.com; SM: Steve@fhi.org.vn Citation: Prybylski D, Acharya LB, Tuladhar SM, Dhungel N, Gautam BR, McPherson J, Gurbacharyta VL, Mills S. Using surveillance data to evaluate a large-scale HIV highway intervention targeting female sex workers in the Terai region of Nepal. jHASE 2011, 3(1):1. Freely available from: http://www.ieph.org/ojs/index.php/jHASE/issue/archive [DOI: pending | predoi ver.04.16.2011] Summary of prepublication history: Resubmission date: 15 May 2010; Acceptance date: 16 April 2011; Publication date: 30 April 2011 Copyright: © 2011 Prybylski et al. licensee jHASE at IEPH, Inc. This open access article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (http://creativecommons.org/licenses/by/2.0). Abstract Objectives: To evaluate the effectiveness of the scaled- up ‘Safe Highway’ HIV intervention program among female sex workers (FSWs) in the Terai region of Nepal after a quasi- experimental pre-surveillance study demonstrated the efficacy of the program on a limited scale. Methods: Analysis of data from multiple rounds of behavioral surveillance surveys (BSS, 1998- 2002) and integrated bio-behavioral surveys (IBBS, 1999, 2003, 2006) conducted among FSWs. Results: Surveillance trend data indicates that there have been steady and statistically significant increases in key condom use indicators and decreases in HIV prevalence over time during which time the Safe Highway program was scaled up and coverage increased significantly. Condom use during last sex with a client increased steadily from 42.1% in 1999 to 68.0% in 2006 ( P<0.001). HIV prevalence decreased steadily from 3.9% in 1999 to 1.5% in 2006 ( P<0.05). Syphilis prevalence also decreased significantly during this time from 11.7% in 1999 to 4.3% in 2006 ( P<0.001) but no decreases were observed for gonorrhea or Chlamydia prevalence. Multiple logistic regression analysis of the 2006 data that adjusted for potential confounding variables showed statistically significant associations ( P<0.001) between exposure to numerous intervention program components (peer education/outreach work, community awareness events, and STI clinic visits) and condom use with clients. Conclusions: The results suggest that the Safe Highway intervention program has significantly contributed to increasing condom use between FSWs and their clients along the East-West highway districts in the Terai region of Nepal.