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Avanceña ALV, Brody C, Chhoun P, Tuot S, Yi S. Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link. JMIR Form Res 2024; 8:e52734. [PMID: 39052328 PMCID: PMC11310643 DOI: 10.2196/52734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 04/04/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Mobile Link is a mobile phone-based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. OBJECTIVE This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. METHODS We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link's messaging and outreach services to 70% of female entertainment workers in 5 years. RESULTS The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval -0.088 to 0.126) DALYs averted, Mobile Link's cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. CONCLUSIONS This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. TRIAL REGISTRATION ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842.
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Affiliation(s)
- Anton L V Avanceña
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Pehn, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Namukisa M, Kamacooko O, Lunkuse JF, Ruzagira E, Price MA, Mayanja Y. Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1089104. [PMID: 36910339 PMCID: PMC9995850 DOI: 10.3389/frph.2023.1089104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
Background In sub-Saharan Africa, one in every five young women becomes pregnant, and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes and a high abortion rate, yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who were frequently engaged in transactional sex in Kampala, Uganda. Methods We analyzed data from a study that investigated the uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on sociodemographics, sexual behavior, reproductive health outcomes, and substance use. Pregnancy was determined by testing for beta-human chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan-Meier technique, and logistic regression was used to determine the correlates of pregnancy. Results We included 285 volunteers with a mean age of 19.9 [standard deviation (SD), ± 2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to the interview, of whom 12.8% consumed alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhoeae. The mean age at first sexual intercourse was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow-up, an incidence of 23.5 per 100 person-years [95% confidence interval (CI), 17.5-31.6]. Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months [adjusted risk ratio (aRR) 1.97; 95% CI, 1.05-3.70] and those who reported not using contraception (aRR 5.89; 95% CI, 2.74-12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI, 0.30-0.90). Conclusion The incidence of unintended pregnancy was high despite the availability of free contraceptive services. We recommend sociobehavioral studies to explore this further. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.
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Affiliation(s)
- Mary Namukisa
- Department of Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Kamacooko
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt A. Price
- Department of Epidemiology, IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Yunia Mayanja
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
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Asare K, Osman F, Ngcapu S, Vandormael A, Naicker N, Khanyile M, Mindel A, Abdool Karim SS, Tomita A, Garrett N. Burden of sexually transmitted infections from acute HIV infection among women in South Africa: Evidence from a prospective cohort study. Ann Epidemiol 2022; 74:132-139. [PMID: 35977656 DOI: 10.1016/j.annepidem.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE HIV and other sexually transmitted infections (STIs) often co-occur. However, less evidence exists on the long-term STI dynamics among persons living with HIV in sub-Saharan Africa to inform interventions. We investigated the incidence, prevalence and factors associated with STIs, starting from acute HIV infection in a cohort of South African women. METHODS The CAPRISA002 study enrolled women with acute HIV infection and performed STI testing and treatment 1-2 times annually from 2004-2020. We estimated STI incidence, re-infection, and prevalence trends before and after antiretroviral treatment (ART). We fitted Cox regression models to identify factors associated with STIs. RESULTS We followed up 235 women (median age = 25 years, IQR 22-29) for 7.5 years (IQR 5.7-10.8). New STI and re-infection cases per 100 person-years (PYs) were 5.1 and 9.5 for Neisseria gonorrhoeae (NG), 7.4 and 14.7 for Chlamydia trachomatis (CT), 8.0 and 26.6 for Trichomonas vaginalis (TV), 7.7 and 16.7 for Mycoplasma genitalium (MG) and 25.2 and 37.3 for any STI. STI incidence, was associated with HIV log10 viral load (AHR = 1.24, 95% CI 1.06-1.44), active syphilis (AHR = 16.55, 95% CI 7.49-36.55), a positive HSV-2 PCR (AHR = 1.54, 95% CI 1.01-2.35), bacterial vaginosis (AHR = 1.48, 95% CI 1.01-2.18), recent regular sexual partners at enrolment (one vs none: AHR = 2.62, 95% CI 1.41-4.87; two plus vs none: AHR = 3.68, 95% CI 1.79-7.59) and age (5-year fold: AHR = 0.80, 95% CI 0.70-0.92). CONCLUSION The persistent STI/HIV co-infection burden among South African women highlights that early HIV diagnosis and ART initiation needs to be combined with better STI care for women and their partners to prevent HIV and STI transmission.
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Affiliation(s)
- Kwabena Asare
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Farzana Osman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Mlungisi Khanyile
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Department of Epidemiology, Columbia University, New York, New York, USA
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel Garrett
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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Oy S, Chhoun P, Tuot S, Brody C, Gorbach PM, Yi S. Gender-based violence, psychological distress, sexual behaviours and binge drinking among female entertainment workers in Cambodia: a cross-sectional study. BMJ Open 2022; 12:e054139. [PMID: 35473722 PMCID: PMC9045091 DOI: 10.1136/bmjopen-2021-054139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the relationship between gender-based violence, HIV risks, psychological distress and binge drinking among female entertainment workers (FEWs) in Cambodia. DESIGN Cross-sectional study. SETTING Phnom Penh and three other provinces in Cambodia. PARTICIPANTS We recruited 600 FEWs from entertainment venues using a stratified random sampling method. Participants were eligible if they were at least 18 years old, working in the selected entertainment venues and self-identified as a FEW. PRIMARY OUTCOME MEASURE Binge drinking was defined as drinking more than five units of alcoholic drinks in 24 hours on at least one occasion in the past 3 months. RESULTS The prevalence of binge drinking was 76.7%. Adjusted odds of binge drinking were significantly higher among FEWs who earned >US$250 per month than those who earned ≤US$120 per month (adjusted OR (AOR) 2.96, 95% CI: 1.40 to 6.24), had been forced to drink more than once per month in the past 3 months than those who had never been forced to drink (AOR 5.66, 95% CI: 2.19 to 14.65), worked at karaoke bars than those working at a restaurants/café (AOR 1.85, 95% CI: 1.19 to 2.88) and experienced emotional abuse in the past 6 months than those who did not experience it (AOR 2.71, 95% CI: 1.22 to 6.02). The odds of binge drinking were significantly higher among FEWs with lower psychological distress than those with higher psychological distress (AOR 1.65, 95% CI: 1.09 to 2.49). CONCLUSIONS This study highlights a high prevalence of binge drinking among FEWs and its associations with working environments, conditions and contexts. Our findings suggest that individual-based behavioural intervention may not effectively reduce binge drinking among FEWs. Structural and occupational health policy interventions may be needed to change the working environment.
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Affiliation(s)
- Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Carinne Brody
- Public Health Program, Touro University California, Vallejo, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
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Brody C, Chhoun P, Tuot S, Fehrenbacher AE, Moran A, Swendeman D, Yi S. A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial. J Med Internet Res 2022. [PMID: 34982716 DOI: 10.21203/rs.3.rs-154027/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. OBJECTIVE This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. METHODS A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. RESULTS A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. CONCLUSIONS The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs' health outcomes in the future. TRIAL REGISTRATION Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-018-2614-7.
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Affiliation(s)
- Carinne Brody
- Public Health Program, Touro University California, Vallejo, CA, United States
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Anne E Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Alexander Moran
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Siyan Yi
- Public Health Program, Touro University California, Vallejo, CA, United States
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Brody C, Chhoun P, Tuot S, Fehrenbacher AE, Moran A, Swendeman D, Yi S. A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial. J Med Internet Res 2022; 24:e27696. [PMID: 34982716 PMCID: PMC8767471 DOI: 10.2196/27696] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/03/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective This study evaluated the efficacy of the Mobile Link intervention in improving FEWs’ health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future. Trial Registration Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2614-7
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Affiliation(s)
- Carinne Brody
- Public Health Program, Touro University California, Vallejo, CA, United States
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Anne E Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Alexander Moran
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Siyan Yi
- Public Health Program, Touro University California, Vallejo, CA, United States.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Meshram PD, Ratta AK. Aspects of working with female sex workers: Perspectives of NGOs implementing targeted intervention projects in HIV/AIDS. J Family Med Prim Care 2020; 9:5171-5176. [PMID: 33409183 PMCID: PMC7773085 DOI: 10.4103/jfmpc.jfmpc_858_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/14/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022] Open
Abstract
Context: HIV continues to be a major global public health issue. Links between sex work and HIV vulnerability have been recognized since the earliest days of the epidemic. Targeted Interventions (TIs) are aimed at offering prevention and care services to high risk populations within communities. Present research is an endeavor to grasp the different aspects indigenous to NGOs implementing TI projects. Aim: To understand the perspectives of NGOs implementing TIs projects for prevention of HIV/AIDS in Female Sex Workers. Settings and Design: A cross sectional qualitative study. Methods and Materials: Six NGOs registered with District AIDS Control Society, working for implementation of TIs projects for FSWs in a Metropolitan City were studied. Statistical Analysis: Data was analysed with SPSS version 20. Results: Rapid turnover of ORWs is major constraint faced by project managers in recruitment of ORWs. In PEs' recruitment, availability of candidates is major constraint. Stigma related to STI clinic and interference of key stakeholders are the major barriers preventing service utilization by FSWs. Client's dislike for using condom is one of the major barriers in condom utilization by FSWs. Conclusion: The realistic problems, constraints experienced by the programme managers became evident during the study. Integration of programs into the existing system and interventions should be tailor-made to local needs. Here lies the opportunity of 'Operational Research' for the institute like NACO to have the practical insights from TI projects.
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Affiliation(s)
- Pravin D Meshram
- Assistant Professor, Department of Community Medicine, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India
| | - Amandeep K Ratta
- National Programme Officer, Maternal Health, Norway India Partnership Initiative, New Delhi, India
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