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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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.

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Authors & affiliation: 
Lafort Y1, Greener L2, Lessitala F3, Chabeda S4, Greener R2, Beksinska M2, Gichangi P1,4,5, Griffin S3, Smit JA2, Chersich M1,6, Delva W1,7,8,9. Author information 1 International Centre for Reproductive Health, Ghent University, Gent, Belgium. 2 Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa. 3 International Centre for Reproductive Health-Mozambique, Maputo, Mozambique. 4 International Centre for Reproductive Health-Kenya, Mombasa, Kenya. 5 University of Nairobi, Nairobi, Kenya. 6 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 7 The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa. 8 Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 9 Center for Statistics, Hasselt University, Diepenbeek, Belgium.
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Published In: 
Trop Med Int Health. 2018 Jul;23(7):774-784. doi: 10.1111/tmi.13072. Epub 2018 May 25.
Publication date: 
Friday, May 25, 2018