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Title: Effect of a "diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities
Authors: Lafort, Yves
Greener, Letitia
Lessitala, Faustino
Chabeda, Sophie
Greener, Ross
Beksinska, Mags
Gichangi, Peter
Griffin, Sally
Smit, Jenni A.
Chersich, Matthew
Delva, Wim 
Issue Date: 2018
Publisher: WILEY
Abstract: ObjectivesTo 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. MethodsWe 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. ResultsIn 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. ConclusionSRH 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.
ObjectifsPour ameliorer l'utilisation des services de sante sexuelle et reproductive (SSR) par les travailleuses du sexe, nous avons mene une etude d'implementation dans laquelle nous avons pilote et teste des interventions diagonales' specifiques au contexte, combinant des interventions verticales ciblees avec un acces ameliore horizontalement aux services de sante generaux, dans trois villes d'Afrique subsaharienne.MethodesNous avons collecte des indicateurs de l'utilisation des services de SSR au moyen d'interviews de face a face avec environ 400 travailleuses du sexe, avant et apres l'intervention, a Durban, en Afrique du Sud; a Tete, au Mozambique et a Mombasa, au Kenya, recrutees par echantillonnage guide par les repondants. Les changements dans l'adoption ont ete testes pour leur signification statistique en utilisant des modeles de regression logistique multivariee.ResultatsDans toutes les villes, l'utilisation globale des services a augmente. L'utilisation si besoin de tous les services de contraception, IST, depistage du VIH, soins du VIH, depistage du cancer du col de l'uterus et violence sexuelle, est passee de 12,5% a 41,5% a Durban, de 25,0% a 40,1% a Tete et de 44,9% a 69,1% a Mombasa. Dans les villes, l'effet a ete le plus important pour le depistage du VIH au cours des six derniers mois, en passant de 40,9% a 83,2% a Durban, de 56,0% a 76,6% a Tete et de 70,9% a 87,6% a Mombasa. A Tete et a Mombasa, l'augmentation de l'utilisation des services de SSR etait presque entierement due a une plus grande utilisation des services cibles. C'est seulement a Durban que l'utilisation des services de sante generaux a augmente.ConclusionL'utilisation des services de SSR s'est amelioree a court terme dans trois contextes differents d'Afrique subsaharienne, principalement a travers des composantes verticales ciblees. L'efficacite a long terme des approches diagonales, en particulier sur l'utilisation des services de sante generaux et horizontaux, devrait etre etudiee en plus.
Notes: [Lafort, Yves; Gichangi, Peter; Chersich, Matthew; Delva, Wim] Univ Ghent, Int Ctr Reprod Hlth, De Pintelaan 185 UZP114, B-9000 Ghent, Belgium. [Greener, Letitia; Greener, Ross; Beksinska, Mags; Smit, Jenni A.] Univ Witwatersrand, Fac Hlth Sci, Maternal Adolescent & Child Hlth Res Unit, Durban, South Africa. [Lessitala, Faustino; Griffin, Sally] Int Ctr Reprod Hlth Mozambique, Maputo, Mozambique. [Chabeda, Sophie; Gichangi, Peter] Int Ctr Reprod Hlth Kenya, Mombasa, Kenya. [Gichangi, Peter] Univ Nairobi, Nairobi, Kenya. [Chersich, Matthew] Univ Witwatersrand, Fac Hlth Sci, Wits Reprod Hlth & HIV Inst, Johannesburg, South Africa. [Delva, Wim] Stellenbosch Univ, South African DST NRF Ctr Excellence Epidemiol Mo, Stellenbosch, South Africa. [Delva, Wim] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Global Hlth, Stellenbosch, South Africa. [Delva, Wim] Hasselt Univ, Ctr Stat, Diepenbeek, Belgium.
Keywords: female sex workers; sexual and reproductive health; HIV prevention and care; care-seeking behaviour; sub-Saharan Africa;female sex workers; sexual and reproductive health; HIV prevention and care; careseeking behaviour; sub-Saharan Africa
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ISSN: 1360-2276
e-ISSN: 1365-3156
DOI: 10.1111/tmi.13072
ISI #: 000437138300009
Category: A1
Type: Journal Contribution
Validations: ecoom 2019
Appears in Collections:Research publications

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