Abstract
BackgroundGlobally, 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.MethodsBetween 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.ResultsWe 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 %).ConclusionsBi-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.
Highlights
Female sex workers (FSW) have a 30-times greater risk of human immunodeficiency virus (HIV) acquisition than women in the general population and are at increased risk of acquiring sexually transmitted infections (STIs) [1]
The median age was 26 years, and 26 years (IQR 22–30) before and after, respectively in Mbarara compared to 28 years (IQR 24–32), and 27 years (IQR 23–31) in Mbale
0.44 0.98 0.93 of testing in the prior three months was lower among female sex workers (FSW) who did not receive a text message reminder or peer education (28 % vs.17 %) when compared with FSW who received a text reminder or peer education [aPR] 0.72, 95 % Confidence interval (CI): 0.51–1.02 and [aPR] 0.83, 95 % CI: 0.58– 1.19) respectively (Table 5). In this pilot quasi-experimental study, in which we assessed the effect of peer education and text message reminders on intentions and uptake of syphilis and HIV testing among FSW, there was a three-fold increase in the proportion of FSW intending to take a syphilis serology test in the three months and a two-fold increase in self-report of ever testing for syphilis in the prior three months in Mbarara, the intervention city, relative to baseline
Summary
Female sex workers (FSW) have a 30-times greater risk of human immunodeficiency virus (HIV) acquisition than women in the general population and are at increased risk of acquiring sexually transmitted infections (STIs) [1]. The World Health Organization (WHO) recommends that FSW test for STIs like syphilis every 3–6 months, and for HIV every 6–12 months [4,5,6]. Ulcerative STIs - syphilis, gonorrhoeae, and herpes simplex virus type 2 (HSV-2) increase HIV acquisition and transmission risk [7,8,9]. Female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). 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
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