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Abstract
BackgroundAs part of a community-randomized trial of a multicomponent intervention to prevent sexually transmitted infections, we created Mobile Teams (MTs) in ten intervention cities across Peru to improve outreach to female sex workers (FSW) for strengthened STI prevention services. MethodsThroughout 20 two-month cycles, MTs provided counseling; condoms; screening and specific treatment for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and vaginal Trichomonas vaginalis (TV) infections; and periodic presumptive metronidazole treatment for vaginal infections. ResultsMTs had 48,207 separate encounters with 24,814 FSW; numbers of sex work venues and of FSW reached increased steadily over several cycles. Approximately 50% of FSW reached per cycle were new. Reported condom use with last client increased from 73% to 93%. Presumptive metronidazole treatment was accepted 83% of times offered. Over 38 months, CT prevalence declined from 15·4% to 8·2%, and TV prevalence from 7·3% to 2·6%. Among participants in ≥9 cycles, CT prevalence decreased from 12·9% to 6·0% (p <0·001); TV from 4·6% to 1·5% (p <0·001); and NG from 0·8% to 0·4% (p =0·07). ConclusionsMobile outreach to FSW reached many FSW not utilizing government clinics. Self-reported condom use substantially increased; CT and TV prevalences declined significantly. The community-randomized trial, reported separately, demonstrated significantly greater reductions in composite prevalence of CT, NG, TV, or high-titer syphilis serology in FSW in these ten intervention cities than in ten matched control cities.
Highlights
Sex workers experience high risk for acquisition and transmission of sexually transmitted infections (STIs)[1]
female sex workers (FSW) participation increased from 1,624 women in cycle 1, leveling off after cycle 7, with 2,432 women reached in cycle 19 (Figure 1), indicating increased numbers of FSW receiving services, and numbers of sex venues reached over time
We have shown that nationally coordinated, locally implemented Mobile Teams (MTs) outreach for STI screening and specific treatment services, metronidazole presumptive treatment (PPT), and risk reduction counseling with condom promotion and provision, provided an effective, feasible approach toward achieving STI control, complementing existing clinic-based services for a high risk, mobile populations
Summary
Sex workers experience high risk for acquisition and transmission of sexually transmitted infections (STIs)[1]. Mathematical modeling suggests condom promotion and repeat STI screening and treatment of female sex workers (FSW) can reduce HIV incidence and prevalence among FSW[2] and lower population-level STI prevalences[3] Interventions employing both strategies have achieved success[4] increasing FSW condom use across all studies[5,6,7,8,9,10,11,12,13,14,15,16] and decreasing STI in most studies, the impact on specific STI has varied, for Chlamydia trachomatis (CT) infection[5,6,8,9,10,11,12,14,15,16,17]. The community-randomized trial, reported separately, demonstrated significantly greater reductions in composite prevalence of CT, NG, TV, or high-titer syphilis serology in FSW in these ten intervention cities than in ten matched control cities
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