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Multicenter Study
. 2018 Jul;23(7):774-784.
doi: 10.1111/tmi.13072. Epub 2018 May 25.

Effect of a 'Diagonal' Intervention on Uptake of HIV and Reproductive Health Services by Female Sex Workers in Three sub-Saharan African Cities

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Free article
Multicenter Study

Effect of a 'Diagonal' Intervention on Uptake of HIV and Reproductive Health Services by Female Sex Workers in Three sub-Saharan African Cities

Yves Lafort et al. Trop Med Int Health. .
Free article

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.

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