Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities


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.
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.
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.
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.
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