{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T06:58:43Z","timestamp":1764140323501,"version":"3.46.0"},"reference-count":36,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women engaged in sex work (WESW) in Uganda face a high risk of HIV and other sexually transmitted infections (STIs), driven by the intersection of gender inequality, poverty and structural barriers. This paper reports on the Kyaterekera Project, a cluster\u2010randomized controlled trial (c\u2010RCT) testing the efficacy of a combined HIV risk reduction (HIVRR) and economic empowerment intervention to reduce biologically confirmed STIs and HIV risk behaviours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study recruited 542 WESW from 19 HIV hotspots across four districts in Uganda between June 2019 and March 2020. Participants were randomized into three groups: (1) HIVRR intervention alone; (2) HIVRR combined with financial literacy training and an unconditional matched savings account; or (3) HIVRR combined with financial literacy training and an unconditional matched savings account and vocational training. Although initially implemented as a three\u2010arm c\u2010RCT, the COVID\u201019 lockdown prevented the implementation of the vocational training component. Therefore, the two treatment groups were combined, and the trial was re\u2010approved as a two\u2010arm c\u2010RCT. Biological assessments were conducted at baseline, 18 and 24 months. Behavioural assessments were conducted at baseline, 6, 12, 18 and 24 months from April 2019 to December 2023. Primary outcomes included incident HIV acquisitions (seroconversions among baseline HIV\u2010negative participants), point prevalence of STIs at each visit, and the number\/proportion of unprotected sexual acts with paying and regular partners. This study utilized community\u2010based participatory research methods, engaging a community advisory board to ensure the study's alignment with local needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across follow\u2010up, condomless sex with paying partners decreased and income shifted towards non\u2010sex work in both arms; no between\u2010group differences were detected. Eighteen incident HIV acquisitions occurred (14 by 18 months; 4 additional by 24 months) with no between\u2010group differences. STI prevalence was lower at 18 months compared to baseline, but not sustained at 24 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In an environment of high baseline HIV prevalence, substantial pre\u2010exposure prophylaxis uptake and COVID\u201019 disruptions, the added financial literacy\/savings components did not yield measurable incremental benefits over HIVRR alone. Integrating an unconditional matched\u2010savings model within an HIVRR platform was feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Number<\/jats:title>\n                    <jats:p>NCT03583541<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70057","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T10:52:26Z","timestamp":1762771946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A cluster\u2010randomized controlled trial of a combination HIV risk reduction and economic empowerment intervention for women engaged in sex work in Uganda"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5336-3185","authenticated-orcid":false,"given":"Susan S.","family":"Witte","sequence":"first","affiliation":[{"name":"School of Social Work Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred M.","family":"Ssewamala","sequence":"additional","affiliation":[{"name":"Brown School Washington University in St. Louis  St. Louis Missouri USA"},{"name":"International Center for Child Health and Development Masaka Field Office  Masaka Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Kiyingi","sequence":"additional","affiliation":[{"name":"Division of Prevention Science Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scarlett L.","family":"Bellamy","sequence":"additional","affiliation":[{"name":"School of Public Health Boston University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyla Sunyoung","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Social Work Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Proscovia","family":"Nabunya","sequence":"additional","affiliation":[{"name":"Brown School Washington University in St. Louis  St. Louis Missouri USA"},{"name":"International Center for Child Health and Development Masaka Field Office  Masaka Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozge Sensoy","family":"Bahar","sequence":"additional","affiliation":[{"name":"Brown School Washington University in St. Louis  St. Louis Missouri USA"},{"name":"International Center for Child Health and Development Masaka Field Office  Masaka Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa Jennings","family":"Mayo\u2010Wilson","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8997-8897","authenticated-orcid":false,"given":"Yesim","family":"Tozan","sequence":"additional","affiliation":[{"name":"School of Global Public Health New York University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abel","family":"Mwebembezi","sequence":"additional","affiliation":[{"name":"Reach the Youth Uganda  Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kagaayi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Kalisizo Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"UNAIDS.World AIDS Day 2023 Global HIV Statistics [Internet]. 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