Learning Explainable Interventions to Mitigate HIV Transmission in Sex Workers Across Five States in India

Abstract: Female sex workers(FSWs) are one of the most vulnerable and stigmatized groups in society. As a result, they often suffer from a lack of quality access to care. Grassroot organizations engaged in improving health services are often faced with the challenge of improving the effectiveness of interventions due to complex influences. This work combines structure learning, discriminative modeling, and grass-root level expertise of designing interventions across five different Indian states to discover the influence of non-obvious factors for improving safe-sex practices in FSWs. A bootstrapped, ensemble-averaged Bayesian Network structure was learned to quantify the factors that could maximize condom usage as revealed from the model. A discriminative model was then constructed using XgBoost and random forest in order to predict condom use behavior The best model achieved 83% sensitivity, 99% specificity, and 99% area under the precision-recall curve for the prediction. Both generative and discriminative modeling approaches revealed that financial literacy training was the primary influence and predictor of condom use in FSWs. These insights have led to a currently ongoing field trial for assessing the real-world utility of this approach. Our work highlights the potential of explainable models for transparent discovery and prioritization of anti-HIV interventions in female sex workers in a resource-limited setting.