\u201cMy condition is my secret\u201d: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

Lydia Atuhaire,Peter S Nyasulu,Constance S Shumba

doi:10.1186/s12913-022-07561-x

Abstract

BackgroundDifferentiated service delivery (DSD) models for female sex workers (FSWs) continue to be scaled up with the goal of expanding access to HIV services and treatment continuity. However, little is known about FSWs’ perspectives on their preferences, facilitators, and barriers to the effective utilization of various DSD models.MethodsWe conducted 24 in-depth interviews among FSWs on antiretroviral therapy for at least one year in two drop-in centres and two public health facilities in Kampala, Uganda in January 2021.ResultsThe facility-based individual management model was most preferred, due to a wide array of comprehensive health services, privacy, and professional health workers. Community DSD models were physically accessible, but least preferred due to stigmatization and discrimination, lack of privacy and confidentiality, and limited health services offered.ConclusionTargeted strategies to reduce stigma and discrimination and the provision of high-quality services have potential to optimise FSWs’ access to HIV services.

Highlights

The differentiated service delivery (DSD) models have been implemented in many countries for the last six years since the World Health Organisation (WHO) [1] released new antiretroviral therapy (ART) guidelines with Differentiated service delivery (DSD) models, and a subsequent decision framework on differentiated ART services for Key populations (KPs) [2]
This study explored the perspectives of female sex workers (FSWs) on DSD models in order, to guide strategies aimed at increasing access to HIV services and retention in HIV care for FSWs
This study has provided critical data based on FSWs’ perspectives on factors that may contribute to the successful implementation of the DSD models

Summary

Introduction

The differentiated service delivery (DSD) models have been implemented in many countries for the last six years since the World Health Organisation (WHO) [1] released new antiretroviral therapy (ART) guidelines with DSD models, and a subsequent decision framework on differentiated ART services for Key populations (KPs) [2]. The facility-based models are Facility based individual management (FBIM), and Facility based groups (FBGs), while the community-based models are community client- led ART delivery model (CCLAD) and community drug distribution points (CDDPs). Examples of such drug pick-up points include DICs, mobile outreaches in hot spots, and community pharmacy pick up points [10]. All community-based models, fast track drug refills as well as a few FBG models serve stable clients, while all the unstable clients are provided services through FBIMs. To be categorized as a stable client, one must have spent more than 12 months on ART, demonstrate good adherence of above 95% and is virally suppressed [10]. Little is known about FSWs’ perspectives on their preferences, facilitators, and barriers to the effective utilization of various DSD models

Methods

Results

Discussion

Conclusion