Outreach Strategies for the Promotion of HIV Testing and Care

Dugas, Marylène; Bédard, Emmanuelle; Batona, Georges; Dubé, Évemie; Alary, Michel

doi:10.1097/qai.0000000000000463

Cited by 20 publications

(16 citation statements)

References 31 publications

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“…Only 15 papers met all criteria [35–49] for inclusion in this synthesis as shown in Table 1. From the quality assessment tool, two studies were rated high [40, 42], 12 studies moderate and one study was rated low quality [43].…”

Section: Resultsmentioning

confidence: 99%

“…Of those, eight studies were conducted among FSWs alone [35, 37, 39, 41, 42, 46–48], while four studies included other study participants, e.g. health providers and clients of FSWs [36, 43–45]. Three studies included FSWs and other key populations, such as men who have sex with men (MSM) [40, 49] and abusive alcohol and cannabis users [38].…”

Section: Resultsmentioning

confidence: 99%

“…Seven papers presented qualitative data from ethnographic studies (mostly collected through in-depth interviews, or a combination of in-depth interviews and participatory group discussions) [36, 39, 41, 43–45, 49]. Four papers were from quantitative studies collected through cross-sectional surveys without comparison groups [40, 42, 47, 48], and three other papers presented data from mixed methods [35, 37, 46].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

et al. 2019

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BackgroundHIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs’ access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services.MethodsA systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported.Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203.ResultsThis review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work.ConclusionsFSWs’ access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6362-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

et al. 2019

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“…While, the World Health Organization (WHO) recommends that high-risk persons undergo HIV testing at least every 12 months, FSW would highly benefit from more frequent testing at least every 6 months. 13 Yet, many FSW do not access HIV testing and counseling, often because of individual, social, and structural barriers, such as the fear a positive result, 14,15 lack of personal motivation, 16,17 insufficient support during testing process, 16,18,19 limited access or distance to HIV testing services, 16 and provider stigma and discrimination. 15,18 Many FSW become aware of their HIV infection as a result of opt out testing during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

Lancaster

Lungu

et al. 2016

International Journal of Drug Policy

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Background HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and marijuana use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. Methods From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and marijuana use and lack of HIV infection awareness. Results Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current marijuana use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). Conclusion Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.

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“…Community- and home-based outreach has previously been shown to be effective in reaching underserved populations with both HIV testing and contraceptive services ( 33 – 36 ). Few studies have assessed the effect of clinical outreach specifically targeting sex workers in resource-limited settings, but those that did conclude that it allowed larger numbers to be reached ( 37 , 38 ). Our study also suggests that it is the most effective way to rapidly increase uptake.…”

Section: Discussionmentioning

confidence: 99%

Impact of a “Diagonal” Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study

Lafort

Lessitala

Melo

et al. 2018

Front. Public Health

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BackgroundFemale sex workers (FSWs) have high risks for adverse sexual and reproductive health (SRH) outcomes, yet low access to services. Within an implementation research project enhancing uptake of SRH services by FSWs, we piloted a “diagonal” intervention, which combined strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal), and tested its effect.MethodsThe study applied a convergent parallel mixed-methods design to assess changes in access to SRH services. Results of structured interviews with FSWs pre-intervention (N = 311) and thereafter (N = 404) were compared with the findings of eight post-intervention focus group discussions (FGDs) with FSWs and two with FSW-peer educators (PEs).ResultsMarked and statistically significant rises occurred in consistent condom use with all partners (55.3–67.7%), ever use of female condoms (37.9–54.5%), being tested for HIV in the past 6 months (56.0–76.6%), using contraception (84.5–95.4%), ever screened for cervical cancer (0.0–16.9%) and having ≥10 contacts with a PE in the past year (0.5–24.45%). Increases mostly resulted from FSW-targeted outreach, with no rise detected in utilization of public health facilities. FGD participants reported that some facilities had become more FSW-friendly, but barriers such as stock-outs, being asked for bribes and disrespectful treatment persisted.ConclusionThe combination of expanding FSW-targeted SRH services with improving access to the public health services resulted in an overall increased uptake of services, but almost exclusively because of the strengthened targeted (vertical) outreach services. Utilization of public SRH services had not yet increased and many barriers to access remained. Our diagonal approach was thus only successful in its vertical component. Improving access to the general health services remains nevertheless important and further research is needed how to reduce barriers. Ideally, the combination approach should be maintained and more successful approaches to increase utilization of public services should be explored.

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Outreach Strategies for the Promotion of HIV Testing and Care

Abstract: To increase the use of testing services, an outreach strategy based on community workers or peer educators, along with improved access to testing services, would be well adapted to this context and appreciated by both FSWs and health care workers.

Cited by 20 publications

References 31 publications

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

Impact of a “Diagonal” Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study

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