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Ryan CS, Belizaire MRD, Nanyunja M, Olu OO, Ahmed YA, Latt A, Kol MT, Bamuleke B, Tusiime J, Nsabimbona N, Conteh I, Nyashanu S, Ramadan PO, Woldetsadik SF, Nkata JPM, Ntwari JT, Nzeyimana SD, Ouedraogo L, Batona G, Ndahindwa V, Mgamb EA, Armah M, Wamala JF, Guyo AG, Freeman AYS, Chimbaru A, Komakech I, Kuku M, Firmino WM, Saguti GE, Msemwa F, O-Tipo S, Kalubula PC, Nsenga N, Talisuna AO. Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo. Infect Dis Poverty 2022; 11:118. [PMID: 36461100 PMCID: PMC9716502 DOI: 10.1186/s40249-022-01040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.
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Affiliation(s)
| | | | | | | | - Yahaya Ali Ahmed
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Anderson Latt
- grid.452949.7WHO Sub-Regional Office for Africa, Dakar, Senegal
| | - Matthew Tut Kol
- grid.508167.dAfrica Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bertrand Bamuleke
- grid.463718.f0000 0004 0639 2906WHO Country Office, Brazzaville, Congo
| | - Jayne Tusiime
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Nadia Nsabimbona
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Ishata Conteh
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Patrick Otim Ramadan
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Georges Batona
- grid.463718.f0000 0004 0639 2906WHO Country Office, Brazzaville, Congo
| | | | | | - Magdalene Armah
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | | | | | | | | | - Shikanga O-Tipo
- grid.439056.d0000 0000 8678 0773WHO Country Office, Lusaka, Zambia
| | | | - Ngoy Nsenga
- WHO Country Office, Bangui, Central African Republic
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Boisvert Moreau M, Kintin FD, Atchekpe S, Batona G, Béhanzin L, Guédou FA, Gagnon MP, Alary M. HIV self-testing implementation, distribution and use among female sex workers in Cotonou, Benin: a qualitative evaluation of acceptability and feasibility. BMC Public Health 2022; 22:589. [PMID: 35346119 PMCID: PMC8962183 DOI: 10.1186/s12889-022-12917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Benin, the burden of HIV is disproportionately high among female sex workers (FSWs). HIV testing and knowledge of status are starting points for HIV treatment and prevention interventions. Despite the importance given to testing services in HIV control, its uptake among FSWs remains suboptimal in Benin. HIV self-testing (HIVST) may be useful for increasing testing rates in FSWs. Methods We conducted a pilot study of the distribution of saliva-based HIVST among FSWs in Cotonou and its surroundings, Benin. The HIVST promotion and distribution model included three complementary strategies: community-based, facility-based and secondary distribution. In this qualitative study, we explored the elements influencing HIVST implementation, distribution and use among FSWs. We assessed HIVST acceptability and feasibility in this population. We conducted 29 semi-structured individual interviews with FSWs. Data were interpreted with a thematic analysis method, using the Theoretical Domains Framework. Results Only two FSWs (6.9%) were aware of HIVST before participating in the study. All participants were interested in using HIVST if available in Benin. Many advantages of HIVST were mentioned, including: autonomy, privacy, accessibility, time saving, and the fact that it is a painless test. Barriers to the use of HIVST included: the fear of unreliability, the lack of psychological support and medical follow-up and the possibility of result dissimulation. Participants thought HIVST was easy to use without assistance. HIVST enabled linkage to care for a few FSWs in denial of their HIV-positive status. No case of suicide or violence associated with HIVST was reported. HIVST secondary distribution within FSWs social network was well received. FSWs’ boyfriends and clients showed interest in using the device. Some FSWs reported using HIVST to practice serosorting or to guide their decisions regarding condom use. Conclusions Our study shows a very high level of acceptability for HIVST among FSWs in Cotonou and its surroundings. Results also demonstrate the feasibility of implementing HIVST distribution in Benin. HIVST should be implemented in Benin quickly and free of charge for all individuals at risk of HIV. HIVST offer should be integrated with comprehensive sexual health and prevention services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12917-3.
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Perrault Sullivan G, Guédou FA, Batona G, Kintin F, Béhanzin L, Avery L, Bédard E, Gagnon MP, Zannou DM, Kpatchavi A, Alary M. Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin. BMC Womens Health 2020; 20:248. [PMID: 33167931 PMCID: PMC7650197 DOI: 10.1186/s12905-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. Methods Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. Results Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. Conclusion One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Fernand Aimé Guédou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Georges Batona
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Frédéric Kintin
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Luc Béhanzin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Lisa Avery
- Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emmanuelle Bédard
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Marie-Pierre Gagnon
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département des sciences infirmières, Université Laval, Québec, Canada
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre national hospitalier universitaire HMK de Cotonou, Cotonou, Bénin
| | - Adolphe Kpatchavi
- Département de Sociologie - Anthropologie, Faculté des Lettres, Arts et Sciences Humaines, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
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Ahouada C, Diabaté S, Mondor M, Hessou S, Guédou FA, Béhanzin L, Batona G, Gning NN, Zannou DM, Alary M. Acceptability of pre-exposure prophylaxis for HIV prevention: facilitators, barriers and impact on sexual risk behaviors among men who have sex with men in Benin. BMC Public Health 2020; 20:1267. [PMID: 32819335 PMCID: PMC7441559 DOI: 10.1186/s12889-020-09363-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Benin, men who have sex with men (MSM) do not always use condoms during anal sex. Pre-exposure prophylaxis (PrEP) using Truvada® (tenofovir disoproxil fumarate / emtricitabine) may be a complementary HIV prevention measure for MSM. This study aimed at identifying the potential facilitators and barriers to the use of PrEP. METHODS This was a cross-sectional study conducted in 2018 among male-born MSM aged 18 years or older who reported being HIV-negative or unaware of their HIV status. The participants were recruited by the RDS technique (respondent driven sampling) in six cities of Benin. Logistic regression analyses, adapted to RDS statistical requirements, were performed to identify the factors associated with PrEP acceptability. RESULTS Mean age of the 400 MSM recruited was 26.2 ± 5.0 years. PrEP was known by 50.7% of respondents. The intention to use PrEP was expressed by 90% of MSM. If PrEP effectiveness were 90% or more, 87.8% of the respondents thought they would decrease condom use. In multivariate analysis, the facilitators associated with PrEP acceptability were: not having to pay for PrEP (odds ratio (OR) = 2.39, 95% CI: 1.50-4.46) and its accessibility within MSM networks (OR = 9.82, 95% CI: 3.50-27.52). Only one barrier was significant: the concern that taking PrEP be perceived as marker of adopting HIV risky behaviors (OR = 0.11, 95% CI: 0.04-0.30). CONCLUSION In Benin, not all MSM know about PrEP. But once well informed, the majority seems willing to use it if made available. The free availability of the drug and its accessibility in the MSM networks are important facilitators. The possibility of decrease in condom use should not be a barrier to the prescription of PrEP if made available.
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Affiliation(s)
- Carin Ahouada
- Hopital de Zone Allada, Allada, Benin.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Souleymane Diabaté
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada.,Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Myrto Mondor
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Septime Hessou
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable (CIFRED/UAC), Abomey-Calavi, Bénin
| | | | - Luc Béhanzin
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Georges Batona
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin
| | - Ndeye Ndiagna Gning
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - D Marcel Zannou
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin.,Faculté des Sciences de la Santé, Cotonou, Bénin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada. .,Institut national de santé publique, Québec, Québec, Canada. .,Hôpital du Saint-Sacrement 1050 chemin Ste-Foy Québec, Québec, QC, G1S 4L8, Canada.
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Ahouada C, Diabaté S, Gning NN, Hessou S, Batona G, Guédou FA, Béhanzin L, Zannou MD, Alary M. Acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Benin: a qualitative study. AIDS Care 2019; 32:242-248. [PMID: 31129988 DOI: 10.1080/09540121.2019.1622643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In Benin, consistent condom use among men who have sex with men (MSM) is relatively low and providing them with Pre-exposure prophylaxis (PrEP) could be of great relevance. We aimed to describe PrEP knowledge and intention to use it; identify key facilitators and barriers to PrEP; and describe the perceived impact of PrEP on unsafe sexual behavior. MSM, 18 years or older, HIV-negative or of unknown status, were enrolled in five cities of Benin. Intention to use PrEP was assessed through five focus groups (FG). Data were analyzed using manual thematic sorting. Thirty MSM (six per city) participated in the FG. Mean age (standard deviation) was 27.1 (5.0) years. All participants expressed the intention to use PrEP if made available. Facilitators of PrEP use were: availability of medication, safety, absence of constraints as well as freedom to have multiple sex partners and sex with HIV-positive friends. Barriers were: complex procedures for obtaining medication, size and taste of medication, cost of medication, poor PrEP awareness.. Eighteen men admitted that PrEP could lead to decrease in or even abandonment of condom use. In conclusion, MSM showed openness to use PrEP if available, although they recognized that it could lead to risk compensation.
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Affiliation(s)
- Carin Ahouada
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Bénin.,Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Souleymane Diabaté
- Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.,Département de médecine et spécialités médicales, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | | | | | - Georges Batona
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin
| | | | - Luc Béhanzin
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Marcel D Zannou
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Bénin.,Faculté des Sciences de Santé, Cotonou, Bénin
| | - Michel Alary
- Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada.,Institut national de santé publique, Québec, Canada
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Batona G, Gagnon MP, Guedou AF, Kintin FD, Avocè J, Alary M. Développement et implantation d'une intervention ciblée encourageant le dépistage régulier du VIH chez les travailleuses du sexe au Bénin : application du protocole d' intervention mapping. Glob Health Promot 2018; 25:81-92. [PMID: 30246630 DOI: 10.1177/1757975916663874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article présente le processus suivi pour développer et implanter une intervention ciblée encourageant les femmes travailleuses du sexe (TS) à se faire dépister régulièrement pour le virus de l'immunodéficience humaine (VIH) dans les services de santé adaptés au Bénin. Le modèle de planification d' intervention mapping (IM) de Bartholomew et al. (2006), structuré en six étapes, a servi de référence pour guider le développement et l'implantation de l'intervention. Une analyse des besoins a été réalisée à partir d'une revue de littérature et d'une étude basée sur la théorie du comportement planifié, d'Ajzen (1991). Cette analyse a permis d'identifier les déterminants associés au comportement sur lesquels ont porté les actions de changement. Les méthodes et stratégies d'intervention ont été basées sur des théories et adaptées aux besoins des femmes TS. Les résultats consistent en une intervention de neuf mois visant à couvrir plus de 1200 femmes TS, en impliquant divers acteurs (intervenants communautaires, agents de santé et pairs éducatrices). La perception de contrôle comportemental, la norme descriptive, les connaissances, l'attitude et l'intention d'adopter le dépistage régulier du VIH constituent les cibles d'action. L'intervention comporte des activités visant des changements individuels et environnementaux à travers diverses méthodes comme le counseling motivationnel, l'éducation par les pairs, le modeling, la communication persuasive, le renforcement de capacités et la réorganisation des services cliniques. L'IM a permis de structurer et d'implanter avec transparence une intervention ciblée visant l'adoption d'un comportement favorable à la santé chez les femmes TS. Les enjeux rencontrés et les leçons tirées de l'application de l'IM en contexte africain francophone peuvent inspirer les planificateurs et professionnels pour améliorer leurs interventions en promotion de la santé.
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Affiliation(s)
- Georges Batona
- 1 Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, Canada.,2 Faculté des sciences infirmières, Université Laval, Québec, Canada
| | - Marie-Pierre Gagnon
- 1 Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, Canada.,2 Faculté des sciences infirmières, Université Laval, Québec, Canada
| | | | | | - Josephat Avocè
- 4 Organisation pour les service et la vie (OSV) Jordan, Université d'Abomey Calavi, Cotonou, Bénin
| | - Michel Alary
- 1 Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, Canada.,5 Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada.,6 Institut national de santé publique du Québec (INSPQ), Québec, Canada
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Dugas M, Bédard E, Batona G, Kpatchavi AC, Guédou FA, Dubé E, Alary M. Outreach strategies for the promotion of HIV testing and care: closing the gap between health services and female sex workers in Benin. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S198-205. [PMID: 25723985 DOI: 10.1097/qai.0000000000000463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Regular voluntary counseling and testing is a key component of the fight against HIV/AIDS. In Benin, the project SIDA-1/2/3 established to decrease HIV/sexually transmitted infection (STIs) among female sex workers (FSWs), implemented a multifaceted intervention, including outreach activities. The objective of this article was to present potential advantages and limitations of 3 categories of outreach interventions designed to increase the use of testing services among FSWs in Benin. METHODS This analysis is based on ethnographic fieldwork conducted in Benin from June to December 2012. RESULTS Sixty-six FSWs and 24 health care workers were interviewed. Their narratives revealed 3 main factors impeding the development of appropriate HIV testing behavior. These negative elements can be positioned along a continuum of health care behaviors, with each stage of this continuum presenting its own challenges: fear or lack of motivation to use testing services, inaccessibility of care when the decision to go has been made, and a perceived lack of quality in the care offered at the health care center. Many of these needs seem to be addressed in the outreach strategies tested. However, the study also exposed some potential barriers or limitations to the success of these strategies when applied in this specific context, due to social disruption, mobility, access to care, and hard to reach population. CONCLUSIONS To increase the use of testing services, an outreach strategy based on community workers or peer educators, along with improved access to testing services, would be well adapted to this context and appreciated by both FSWs and health care workers.
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Affiliation(s)
- Marylène Dugas
- *Centre de recherche, CHU de Québec, Québec City, Québec, Canada; †Département des sciences infirmières, Université du Québec à Rimouski, Campus Lévis, Lévis, Québec, Canada; ‡Département des sciences infirmières, Université Laval, Québec City, Québec, Canada; §Faculté des lettres, arts et sciences humaines, Université d'Abomey-Calavi, Abomey-Calavi, Bénin; ‖Dispensaire IST, Cotonou, Bénin; ¶Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada; #Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada; and **Institut national de santé publique du Québec, Québec City, Québec, Canada
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Semini I, Batona G, Lafrance C, Kessou L, Gbedji E, Anani H, Alary M. Implementing for results: program analysis of the HIV/STI interventions for sex workers in Benin. AIDS Care 2013; 25 Suppl 1:S30-9. [PMID: 23745627 PMCID: PMC4003579 DOI: 10.1080/09540121.2013.784392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV response has entered a new era shaped by evidence that the combination of interventions impacts the trajectory of the epidemic. Even proven interventions, however, can be ineffective if not to scale, appropriately implemented, and with the right combination. Benin is among the pioneering countries that prioritized HIV prevention for sex workers and clients early on. Effective implementation up to 2006 resulted in consistent condom use among sex workers increasing from 39% to 86.2% and a decline in prevalence of gonorrhea from 5.4% to 1.6%. This study responds to the growing concern that, although proven interventions for female sex workers (FSWs) were expanded in Benin since 2008, indicators of coverage and behaviors are far from satisfactory. The quest to better understand implementation and how to render service delivery efficient and effective resonates with increased emphasis in the international arena on return for investments. Quantitative and qualitative methods were utilized to collect data. The output measured is the number of sex workers seeking Sexually Transmitted Infection (STI) care at user-friendly STI Clinics (SCs). Data were collected for 2010–2011 in nine regions of Benin. While recognizing that commitment to scale up is commendable, the study revealed deficiencies in program design and implementation that undermine outcomes. The selected mix of interventions is not optimal. Allocation of funds is not proportionate to the needs of FSW across regions. Only 5 of 41 SCs were fully functional at time of study. Free distribution of condoms covers only 10% of needs of FSWs. Funding and financing gaps resulted in extended interruptions of services. Successful HIV prevention in Benin will depend on the effective and efficient implementation of well-funded programs in sex work setting. Resources should be aligned to local sex work typology and presence in communities. A national framework defining an appropriate mix of interventions, management structure, referral mechanisms, and operational standards is required to guide rigorous implementation. Health services, in particular functional and user-friendly SCs coupled with mechanisms that link community-based work and health facilities should be strengthened to ensure STI care/anti-retroviral treatment expansion. Without leadership of sex workers, any attempt to end HIV will be unsuccessful.
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Batona G, Sémini I, Gagnon M, Guedou F, Alary M. P3.401 Implementing For Results: Program Analysis of the HIV/STI Interventions For Sex Workers in Benin. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Batona G, Michel A, Rene K, Marie G, Evelyne A, Clement A, Kamaye IM, Hassane D. LBP-1.05 Challenges and barriers for conducting STI/HIV prevention projects targeting female sex workers within national programs in Benin and Niger. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050119.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Greene E, Batona G, Hallad J, Johnson S, Neema S, Tolley EE. Acceptability and adherence of a candidate microbicide gel among high-risk women in Africa and India. Cult Health Sex 2010; 12:739-754. [PMID: 20397080 DOI: 10.1080/13691051003728599] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vaginal microbicides currently under development are substances that may prevent the transmission of HIV. Qualitative, in-depth post-trial interview data from a Phase III clinical trial of 6% Cellulose Sulfate microbicide gel in two sites in Africa (Uganda and Benin) and two in India (Chennai and Bagalkot) were examined in order to better understand factors that influence microbicide acceptability and adherence in a clinical trial setting. Women found the gel relatively easy to use with partners with whom there were no expectations of fidelity, in situations where they had access to private space and at times when they were expecting to engage in sexual intercourse. Adherence to gel seemed significantly more difficult with primary partners due to decreased perceptions of risk, inconvenience or fear of partner disapproval. Findings suggest that women in a variety of settings may find a microbicide gel to be highly acceptable for its lubricant qualities and protective benefits but that adherence and consistent use may depend greatly on contextual and partner-related factors. These findings have important implications for future trial designs, predicting determinants of microbicide use and acceptability and marketing and educational efforts should a safe and efficacious microbicide be found.
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Affiliation(s)
- Elizabeth Greene
- Family Health International, Research Triangle Park, North Carolina, USA.
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