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Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique

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Abstract
Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed. Results: An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times. Conclusions: Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.
Keywords
SEXUALLY-TRANSMITTED INFECTIONS, FEMALE SEX WORKERS, COST-EFFECTIVENESS, AFRICA, INTERVENTIONS, PREVENTION, HIV/AIDS, DISEASE, KENYA

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Citation

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Chicago
Lafort, Yves, Diederike Geelhoed, Luis Cumba, Carla Das Dores Mosse Lázaro, Wim Delva, Stanley Lüchters, and Marleen Temmerman. 2010. “Reproductive Health Services for Populations at High Risk of HIV: Performance of a Night Clinic in Tete Province, Mozambique.” Bmc Health Services Research 10.
APA
Lafort, Y., Geelhoed, D., Cumba, L., Das Dores Mosse Lázaro, C., Delva, W., Lüchters, S., & Temmerman, M. (2010). Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique. BMC HEALTH SERVICES RESEARCH, 10.
Vancouver
1.
Lafort Y, Geelhoed D, Cumba L, Das Dores Mosse Lázaro C, Delva W, Lüchters S, et al. Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique. BMC HEALTH SERVICES RESEARCH. LONDON: BIOMED CENTRAL LTD; 2010;10.
MLA
Lafort, Yves, Diederike Geelhoed, Luis Cumba, et al. “Reproductive Health Services for Populations at High Risk of HIV: Performance of a Night Clinic in Tete Province, Mozambique.” BMC HEALTH SERVICES RESEARCH 10 (2010): n. pag. Print.
@article{1015543,
  abstract     = {Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.
Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed.
Results: An estimated 4,415 FSW work in the area, or 9\% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43\% for contraception, 24\% for counselling and testing and 23\% for STI care). The average clinic running cost is US\$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times.
Conclusions: Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.},
  articleno    = {144},
  author       = {Lafort, Yves and Geelhoed, Diederike and Cumba, Luis and Das Dores Mosse L{\'a}zaro, Carla and Delva, Wim and L{\"u}chters, Stanley and Temmerman, Marleen},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {SEXUALLY-TRANSMITTED INFECTIONS,FEMALE SEX WORKERS,COST-EFFECTIVENESS,AFRICA,INTERVENTIONS,PREVENTION,HIV/AIDS,DISEASE,KENYA},
  language     = {eng},
  pages        = {9},
  publisher    = {BIOMED CENTRAL LTD},
  title        = {Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique},
  url          = {http://dx.doi.org/10.1186/1472-6963-10-144},
  volume       = {10},
  year         = {2010},
}

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