Yves Lafort 1, Letitia Greener 2, Faustino Lessitala 3, Sophie Chabeda 4, Ross Greener 2, Mags Beksinska 2, Peter Gichangi 1 4 5, Sally Griffin 3, Jenni A Smit 2, Matthew Chersich 1 6, Wim Delva 1 7 8 9
Affiliations
- 1International Centre for Reproductive Health, Ghent University, Gent, Belgium.
- 2Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
- 3International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
- 4International Centre for Reproductive Health-Kenya, Mombasa, Kenya.
- 5University of Nairobi, Nairobi, Kenya.
- 6Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- 7The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.
- 8Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
- 9Center for Statistics, Hasselt University, Diepenbeek, Belgium.
PMID: 29752836
DOI: 10.1111/tmi.13072
Abstract
Objectives: To enhance uptake of sexual and reproductive health (SRH) services by female sex workers (FSWs), we conducted an implementation study in which we piloted and tested context-specific ‘diagonal’ interventions, combining vertical, targeted interventions with horizontally improved access to the general health services, in three cities in sub-Saharan Africa.
Methods: We collected indicators of SRH service uptake through face-to-face interviews with approximately 400 FSWs, pre- and post-intervention, in Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, recruited by respondent-driven sampling. Changes in uptake were tested for their statistical significance using multivariate logistic regression models.
Results: In all cities, overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete and 70.9% to 87.6% in Mombasa. In Tete and Mombasa, rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilisation of general health services.
Conclusion: SRH service utilisation improved in the short-term in three different sub-Saharan African contexts, primarily through vertical, targeted components. The long-term effectiveness of diagonal approaches, in particular on the use of general, horizontal health services, needs further investigation.
Keywords: Afrique subsaharienne; HIV prevention and care; care-seeking behaviour; comportement de recherche de soins; female sex workers; prévention et soins du VIH; santé sexuelle et reproductive; sexual and reproductive health; sub-Saharan Africa; travailleuses du sexe.
© 2018 John Wiley & Sons Ltd.
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