A Mobile Intervention to link Female Entertainment Workers in Cambodia to Health and Gender-based Violence Services: Randomized Controlled Trial (Preprint)

BACKGROUND Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance use, and gender-based violence (GBV) than the general population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. OBJECTIVE This study evaluates the Mobile Link intervention, aiming to improve FEWs’ health by connecting them to health services using automated twice-weekly short message services and voice messages with health information and direct links to outreach workers. METHODS The randomized controlled trial was conducted between March 2018 and June 2019. We employed a stratified random sampling method to select participants from five study sites. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use, which we assessed through face-to-face structured interviews. We also measured secondary outcomes, including contact with outreach workers, escorted referral services use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. RESULTS We included 218 FEWs in intervention and 170 FEWs in control arms in the per-protocol analyses after 212 removing dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (group by time 2 AOR 3.29, 95% CI 1.28–8.47), receiving an escorted referral (group by time 2 AOR 2.86, 95% CI 1.09–7.52; group by time 3 AOR 8.15, 95% CI 1.65–40.25), and never being forced to drink at work (group by time 3 AOR 3.95, 95% CI 1.62–9.60). No significant differences between intervention and control groups over time were observed for any primary outcomes in the fully adjusted models. CONCLUSIONS The Mobile Link intervention did not show an effect on the primary outcomes but effectively connected FEWs with outreach workers and escorted referrals. Reductions in forced drinking at work were also significantly more extensive in the intervention group than the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future. CLINICALTRIAL Clinical trials.gov, NCT03117842 . Registered 31 March 2017, https://clinicaltrials.gov/ct2/show/NCT03117842?term=NCT03117842&rank=1 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2614-7