Abstract
BackgroundDifferent models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.MethodsIn 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed.ResultsAn estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times.ConclusionsSize of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.
Highlights
Different models exist to provide HIV/sexually transmitted infections (STI) services for most-at-risk populations (MARP)
Female sex workers (FSW) are a hard-to-reach, socially and economically vulnerable population with inadequate access to health, social and legal services. They are at increased risk for HIV, sexually transmitted infections (STI) and other sexual and reproductive health and rights problems (SRHR) [1,2,3,4,5]
In large African towns, a model of female sex workers (FSW)-specific clinics is often implemented [10,11,12,13]. This model is less obvious in settings with smaller concentrations of FSW, such as along transport corridors [14], and projects often opt to improve access to HIV/STI services in existing public or private health facilities [15,16]
Summary
Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Female sex workers (FSW) are a hard-to-reach, socially and economically vulnerable population with inadequate access to health, social and legal services. They are at increased risk for HIV, sexually transmitted infections (STI) and other sexual and reproductive health and rights problems (SRHR) [1,2,3,4,5]. In large African towns, a model of FSW-specific clinics is often implemented [10,11,12,13] This model is less obvious in settings with smaller concentrations of FSW, such as along transport corridors [14], and projects often opt to improve access to HIV/STI services in existing public or private health facilities [15,16].
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