Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda

Abstract Background Globally, female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). However, uptake of STI and HIV testing services among FSW in sub-Saharan Africa remains low. We aimed to assess the effect of FSW-led peer education and text message reminders on 3-monthly syphilis and HIV testing among FSW in Uganda. Methods Between September 2019 and February 2020, we implemented weekly peer education sessions and bi-monthly SMS reminders for FSW in Mbarara (intervention city). Peer education sessions were implemented by 20 FSW, who received five days of basic training as peer educators. We held monthly meetings with peer educators throughout the six-month implementation period. FSW in Mbale (control city) continued to receive standard of care consisting of HIV testing outreach campaigns, and facility-based testing. Using a quasi-experimental design in one intervention city, and one control city, we conducted pre- and post- questionnaire-based surveys on recent syphilis and HIV testing behavior among FSW in July-October 2018, and March 2020. We compared proportions and prevalence ratios at baseline and follow-up using chi-square tests and negative binomial regression. Results We conducted 436 interviews (200 before/236 after) with FSW. At baseline similar proportions reported taking an HIV test (57 % vs. 54 %; p = 0.72), and a syphilis serology test (35 % vs. 39 %; p = 0.67) in the intervention and control cities, respectively, in the prior three months. After the intervention, this proportion increased to 82 % (95 % confidence interval [CI] 74.0-88.2) for HIV, and 81 % (95 % CI: 73.0–87.0) for syphilis in the intervention city. Relative to baseline in the control city, the proportion testing for HIV was unchanged (52 %) but decreased for syphilis (26 %). Conclusions Bi-monthly text message reminders with weekly peer education sessions increased uptake of 3-monthly syphilis and HIV testing in a Ugandan female sex work population and could help increase sex worker engagement in HIV/STI services in line with World Health Organization recommendations.

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A Randomized Controlled Trial to Increase HIV Testing Demand Among Female Sex Workers in Kenya Through Announcing the Availability of HIV Self-testing Via Text Message

AIDS and Behavior ◽

10.1007/s10461-018-2248-5 ◽

2018 ◽

Vol 23 (1) ◽

pp. 116-125 ◽

Cited By ~ 12

Author(s):

Elizabeth A. Kelvin ◽

Gavin George ◽

Eva Mwai ◽

Samuel Kinyanjui ◽

Matthew L. Romo ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hiv Testing ◽

Sex Workers ◽

Female Sex Workers ◽

Controlled Trial ◽

Text Message ◽

Randomized Controlled ◽

Female Sex ◽

Self Testing

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Psychosocial correlates of regular syphilis and HIV screening practices among female sex workers in Uganda: a cross-sectional survey

AIDS Research and Therapy ◽

10.1186/s12981-019-0244-0 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Richard Muhindo ◽

Barbara Castelnuovo ◽

Andrew Mujugira ◽

Rosalind Parkes-Ratanshi ◽

Nelson K. Sewankambo ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Self Efficacy ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Hiv Screening ◽

Cross Sectional ◽

Psychosocial Correlates ◽

Female Sex ◽

Syphilis Testing

Abstract Background Limited data are available regarding correlates of regular sexually transmitted infections (STIs) and HIV screening among female sex workers (FSW) in Sub-Saharan Africa. In this study, we aimed to assess the frequency of regular syphilis and HIV screening and the psychosocial correlates associated with screening among FSW in Uganda. Methods This cross-sectional correlational study was conducted among 441 FSW, aged 17–49 years. We enrolled FSW through peer referrals and ascertained self-reported data on number of serological tests for HIV, syphilis and other STIs in the prior 12 months using an interviewer-administered questionnaire. In addition, we assessed attitudes, norms, social influences and self-efficacy towards 3-monthly Syphilis and 6-monthly HIV testing. We estimated the correlates of regular STI and HIV testing using negative binomial regression. Results Of the respondents 420 (95.2%) reported to have ever taken an HIV test with 297 (67.4%) testing two or more times in the prior 12 months. Over half of the respondents (59%) reported ever taking a syphilis test with only 62 (14.1%) reporting testing three or more times in the prior 12 months. After adjusting for socio-demographics, attitude and norms, high perceived self-efficacy was associated with a 33% increase in the likelihood of repeated HIV testing [prevalence ratio (PR), 1.33, 95% confidence interval (CI) 1.15–1.53] while low perceived confidence was associated with a 25% decrease in the likelihood of repeated HIV testing (PR, 0.75, 95% CI 0.63–0.89). Similarly low attitudes and norms were associated with a decrease of 52.6% (PR, 0.47, 95% CI 0.37–0.61) and 47% (PR, 0.53, 95% CI 0.41–0.69) in the likelihood of repeated syphilis testing respectively. Conclusion Compared to HIV, uptake of repeated syphilis testing was very low. Correlates of HIV testing include; perceived self-efficacy amidst barriers and perceived confidence for HIV and low attitudes and accepting norms for syphilis. Health campaigns should emphasize overcoming barriers to HIV testing while promoting attitudes and norms including integration of serological syphilis testing and other STIs into HIV services.

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Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

10.21203/rs.2.12428/v3 ◽

2019 ◽

Author(s):

Soori Nnko ◽

Daniel Nyato ◽

Evodius Kuringe ◽

Caterina Casalini ◽

Amani Shao ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Exploratory Study ◽

Female Sex Workers ◽

Health Care Facilities ◽

Sub Saharan Africa ◽

Hiv Care ◽

Female Sex ◽

Self Testing ◽

Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

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Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

10.21203/rs.2.12428/v2 ◽

2019 ◽

Author(s):

Soori Nnko ◽

Daniel Nyato ◽

Evodius Kuringe ◽

Caterina Casalini ◽

Amani Shao ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Exploratory Study ◽

Female Sex Workers ◽

Health Care Facilities ◽

Sub Saharan Africa ◽

Hiv Care ◽

Female Sex ◽

Self Testing ◽

Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods:We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results:A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

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Determinants of the low uptake of HIV-related intervention services by female sex workers in Shenzhen, China: an observational study (2009–2012)

Sexual Health ◽

10.1071/sh14189 ◽

2015 ◽

Vol 12 (3) ◽

pp. 257 ◽

Cited By ~ 1

Author(s):

Rui Cai ◽

Jingguang Tan ◽

Lin Chen ◽

Caspar W. N. Looman ◽

Jan Hendrik Richardus ◽

...

Keyword(s):

Condom Use ◽

Hiv Testing ◽

Sex Workers ◽

Female Sex Workers ◽

Peer Education ◽

Consistent Condom ◽

Chinese Government ◽

Related Services ◽

Female Sex ◽

Intervention Services

Background Female sex workers (FSWs) are highly vulnerable to HIV but make little use of HIV-related intervention services provided by the Chinese government. Determinants of the low uptake of HIV services by FSWs in Shenzhen, Guangdong province were investigated. Methods: FSWs were recruited by venue-based sampling; 1656 FSWs were interviewed about sociodemographics, behaviours and uptake of HIV-related intervention services. Determinants of no uptake of HIV testing, condom promotion, and peer education were determined through logistic regression. The association between uptake of HIV-related services, condom use and HIV-related knowledge was also assessed. Results: The overall uptake of HIV testing, condom promotion, and peer education by FSWs was 21.5%, 47.8% and 28.0%, respectively. Young age and shorter duration of working in Shenzhen were statistically significantly correlated with no uptake of all three interventions. Uptake of these services was positively associated with consistent condom use and good HIV-related knowledge. Conclusions: The uptake of HIV-related intervention services by FSWs is low in Shenzhen. As their uptake is positively associated with condom use and HIV-related knowledge, it is necessary to intensify promotion of these, focusing on young and recently started FSWs.

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Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

10.21203/rs.2.12428/v1 ◽

2019 ◽

Author(s):

Soori Nnko ◽

Daniel Nyato ◽

Evodius Kuringe ◽

Caterina Casalini ◽

Amani Shao ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Exploratory Study ◽

Risk Perceptions ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Hiv Care ◽

Female Sex ◽

Self Testing ◽

Study Participants

Abstract Background HIV testing is a gateway to HIV care and treatment for those testing positive, and can link those with negative reactive tests to HIV preventive services, including enrolment into pre exposure prophylaxis (PrEP). While benefits of HIV testing services (HTS) are known, uptake of HTS among female sex workers (FSWs) in Tanzania and across sub-Saharan Africa (SSA) remains suboptimal. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS, and contribute to greater linkage to care and prevention services. This study explored perspectives of FSWs towards HIVST, to inform a large-scale combination HIV prevention program addressing key populations (KPs) in Tanzania. Methods We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs. PGD collected normative data e.g. perceptions and attitudes towards HTS, whereas IDI collected personal information e.g. sexual practices and HIV risk perceptions. Study participants were recruited through snowball sampling. Data were thematically analysed using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with feasibility of scale up of HIVST. Results A total of 20 PGD sessions were conducted involving 227 participants. We also conducted IDIs with 21 FSWs. Study participants were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality were primary in participants’ support for the HIVST. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for the FSWs with reactive test – this was related to the lack of professional counselling support in the self-testing environment. Conclusions Increased confidentiality, reduced cost for care, and increased autonomy were among the leading motivations to use HIVST. Major concerns included fear of HIV positive results, and not trusting self-diagnoses. We underscore the importance of providing adequate support services in conjunction with HIVST, e.g. access to counselling and referral services, and user-accessible support to the interpretations of test results.

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Evaluation of a peer education programme for female sex workers in Bali, Indonesia

International Journal of STD & AIDS ◽

10.1258/0956462001915156 ◽

2000 ◽

Vol 11 (11) ◽

pp. 731-733 ◽

Cited By ~ 33

Author(s):

K Ford ◽

D N Wirawan ◽

W Suastina ◽

B D Reed ◽

P Muliawan

Keyword(s):

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Peer Education ◽

Education Programme ◽

Peer Educators ◽

Face To Face ◽

Female Sex ◽

Peer Educator ◽

The Impact

The objective of this paper is to evaluate a peer education programme for female sex workers in Bali, Indonesia. Sex workers participated in face-to-face interviews and STD exams in August-September 1998. In October 1998 one woman from each of 30 clusters was selected to be a peer educator and received a 2-day training on AIDS, STDs, condom use, and condom negotiation. After training, the peer educators were visited twice a week by field workers to answer questions and offer support. All sex workers received group education every 2 months. In January-February 1999, the sex workers again participated in face-to-face interviews and examinations. One month after peer education training, only 50% of the peer educators were still working in the clusters where they were trained. To evaluate the impact of the peer educators, sex workers in clusters where a peer educator continued to work were compared with sex workers in clusters where women did not continue to work ( n = 189). In clusters where women continued to work, there were higher levels of AIDS knowledge ( P < 0.05), STD knowledge ( P < 0.05) and condom use (82 vs 73%, P = 0.15). The prevalence of Neisseria gonorrhoeae infection was also lower in clusters with a peer educator (39% vs 55%, P = 0.05) than in clusters without a peer educator.

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Prevalence of hepatitis B and C among female sex workers in Togo, West Africa

PLoS ONE ◽

10.1371/journal.pone.0259891 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0259891

Author(s):

Alexandra M. Bitty-Anderson ◽

Valentine Ferré ◽

Fifonsi A. Gbeasor-Komlanvi ◽

Martin Kouame Tchankoni ◽

Arnold Sadio ◽

...

Keyword(s):

Hepatitis B ◽

Viral Hepatitis ◽

Sex Workers ◽

Female Sex Workers ◽

Health Sector ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Female Sex ◽

The World

Background Hepatitis B and C are endemic in sub-Saharan Africa, with prevalence among the highest in the World. However, several challenges impede the progression towards the elimination of viral hepatitis by 2030 as suggested by the World Health Organization Global health sector strategy on viral hepatitis, including the lack of knowledge on the scale of this epidemic in the region. The aim of this study was to estimate the prevalence of hepatitis B and C among female sex workers (FSW) in Togo. Methods This ancillary study from a national cross-sectional bio-behavioral study was conducted in 2017 using a respondent-driven sampling (RDS) method, in eight towns of Togo among FSW. Socio-demographic, behavioral and sexual characteristics were assessed using a standardized questionnaire. Blood samples were collected for HIV, hepatitis B and C serological testing. Data were analyzed using descriptive analysis and a logistic regression model. Results Out of the 1,036 FSW recruited for this study, biological analyses for viral hepatitis were completed for 769 of them. The median age was 26 years [IQR: 22–33] and 49.8% (n = 383) had attained secondary school. The prevalence of hepatitis B was 9.9% [95% CI: (7.9–12.2)] and the prevalence of hepatitis C was 5.3% [95% CI: (3.9–7.2)]. Higher hepatitis B and C prevalence was associated with recruitment out of Lomé (aOR: 6.63; 95%CI: 3.51–13.40, p <0.001 and OR: 2.82; 95% CI: [1.37–5.99]; p<0.001, respectively) and, for hepatitis B, with never using condoms for vaginal intercourse (OR: 3.14; 95%CI: [1.02–8.71]; p<0.05). Conclusions Results from this study reveals high prevalence of hepatitis B and C among FSW in Togo and an opportunity for advocacy toward the introduction of immunizations and treatment in this population.

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