1. Project START Intervention Increases HIV Testing Uptake and Decreases HIV Risk Behavior among Men Released from Prison: a Randomized Controlled Study in Ukraine
T. Kiriazova, Y. Sereda, O. Neduzhko, O. Postnov,
R. Yorick, I. Shvab, S. Dvoriak
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine USAID RESPOND, Pact Inc, Kyiv, Ukraine

2. Background & Methods BACKGROUND OUTCOMES STATISTICAL ANALYSIS
In , the USAID's RESPOND Project supported 4 NGOs in 3 regions of Ukraine implementing Project START intervention (EffectiveInterventions.CDC.gov) among prisoners transitioning back into the community.
Intervention: 6 individual counseling sessions (2 pre- and 4 post-release) to decrease risks of HIV, STIs and hepatitis.
This randomized controlled trial assessed whether Project START, adapted to Ukrainian context and implemented with fidelity, would decrease the risk of HIV infection in men who transition from prison to community in Ukraine.
OUTCOMES
Unprotected sex at last intercourse
Inconsistent condom use in the past 3 months (separately for regular and casual partners).
HIV knowledge
HIV testing within the past 12 months
STATISTICAL ANALYSIS
Intent-to-treat analysis compared intervention and control groups at each assessment.
Generalized linear mixed model.
Multivariate imputation by chained equations based on random forest algorithm to address data not missing at random.

3. Results and Conclusions
394 male prisoners were included in the study:
mean age 35.6 ± 9.6 years
mean duration of current imprisonment 38.9 ± 24.1 months
56.9% reported history of injection drug use.
Follow-up rates at 3- and 6-month assessments - 86% and 85% for the intervention and 82% and 82% for the control group.
68% of risk reduction goals were reached by clients within 6 months after release
87% of clients reached more than 50% of their goals
68% of clients accessed the recommended services.
Receiving the intervention was associated with
better HIV testing uptake
better HIV knowledge
lower odds of HIV sexual risk behaviors (unprotected sex at last intercourse and inconsistent condom use with regular and casual partners).

4. Post-release Outcomes Reported by Scheduled Period of Follow-up for Intervention and Control Groups
Baseline
3 months
6 months
Interv.
Contr.
AOR
(95% CI)
Unprotected sex at last intercourse
71%
73%
0.87
( )
40%
58%
0.41
( )
42%
0.35
( )
Inconsistent condom use with regular partners
75%
0.84
( )
52%
0.47
( )
44%
65%
0.30
( )
Inconsistent condom use with casual partners
27%
30%
0.80
( )
12%
24%
( )
11%
20%
0.32
( )
HIV testing
47%
41%
1.51
( )
76%
11.72
( )
80%
56%
6.05
( )
HIV knowledge
51%
0.61
( )
77%
59%
3.38
( )
3.20
( )
Interv. = Intervention; Contr. = Control; AOR = adjusted odds ratio; CI = confidence interval
Both short-term and long-term effects of Project START on recently released male prisoners in three regions of Ukraine.

5. Thank you!