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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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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
SOUTH-AFRICA, COTE-DIVOIRE, CARE, POPULATIONS, BURDEN, ACCESS, KENYA, INDIA, MOZAMBIQUE, NAVIGATION, female sex workers, sexual and reproductive health, HIV prevention and, care, care-seeking behaviour, sub-Saharan Africa

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Citation

Please use this url to cite or link to this publication:

Chicago
Lafort, Yves, Letitia Greener, Faustino Lessitala, Sophie Chabeda, Ross Greener, Mags Beksinska, Peter Gichangi, et al. 2018. “Effect of a ‘Diagonal’ Intervention on Uptake of HIV and Reproductive Health Services by Female Sex Workers in Three sub-Saharan African Cities.” Tropical Medicine & International Health 23 (7): 774–784.
APA
Lafort, Y., Greener, L., Lessitala, F., Chabeda, S., Greener, R., Beksinska, M., Gichangi, P., et al. (2018). Effect of a “diagonal” intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities. TROPICAL MEDICINE & INTERNATIONAL HEALTH, 23(7), 774–784.
Vancouver
1.
Lafort Y, Greener L, Lessitala F, Chabeda S, Greener R, Beksinska M, et al. Effect of a “diagonal” intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2018;23(7):774–84.
MLA
Lafort, Yves, Letitia Greener, Faustino Lessitala, et al. “Effect of a ‘Diagonal’ Intervention on Uptake of HIV and Reproductive Health Services by Female Sex Workers in Three sub-Saharan African Cities.” TROPICAL MEDICINE & INTERNATIONAL HEALTH 23.7 (2018): 774–784. Print.
@article{8570727,
  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.},
  author       = {Lafort, Yves and Greener, Letitia and Lessitala, Faustino and Chabeda, Sophie and Greener, Ross and Beksinska, Mags and Gichangi, Peter and Griffin, Sally and Smit, Jenni A and Chersich, Matthew and Delva, Wim},
  issn         = {1360-2276},
  journal      = {TROPICAL MEDICINE \& INTERNATIONAL HEALTH},
  keyword      = {SOUTH-AFRICA,COTE-DIVOIRE,CARE,POPULATIONS,BURDEN,ACCESS,KENYA,INDIA,MOZAMBIQUE,NAVIGATION,female sex workers,sexual and reproductive health,HIV prevention and,care,care-seeking behaviour,sub-Saharan Africa},
  language     = {eng},
  number       = {7},
  pages        = {774--784},
  title        = {Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities},
  url          = {http://dx.doi.org/10.1111/tmi.13072},
  volume       = {23},
  year         = {2018},
}

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