Confidential, accessible point-of-care sexual health services to support the participation of key populations in biobehavioural surveys: Lessons for Papua New Guinea and other settings where reach of key populations is limited

Abstract

To achieve the UNAIDS 90-90-90 targets at a national level, many countries must accelerate service coverage among key populations. To do this, key population programs have adopted methods similar to those used in respondent-driven sampling (RDS) to expand reach. A deeper understanding of factors from RDS surveys that enhance health service engagement can improve key population programs. To understand the in-depth lives of key populations, acceptance of expanded point-of-care biological testing and determine drivers of participation in RDS surveys, we conducted semi-structured interviews with 111 key population participants (12-65 years) were purposefully selected from six biobehavioral surveys (BBS) in three cities in Papua New Guinea. Key populations were female sex workers, men who have sex with men, and transgender women. Four reasons motivated individuals to participate in the BBS: peer referrals; private, confidential, and stigma-free study facilities; "one-stop shop" services that provided multiple tests and with same-day results, sexually transmitted infection treatment, and referrals; and the desire to know ones' health status. Biobehavioral surveys, and programs offering key population services can incorporate the approach we used to facilitate key population engagement in the HIV cascade.

A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea

“…The findings of the study presented below are divided into individual, interpersonal and institutional factors that enhanced or inhibited effective treatment initiation and adherence among participants in the three study locations. While the behavioural and clinical data from Kauntim mi tu has been presented separately [ 18 , 33 ], in this paper we draw on the qualitative data generated from both populations (FSW = 23; MSM =5) to examine the socio-ecological factors affecting key populations in PNG. We have successfully combined the qualitative data elsewhere to understand participation in the study, and the role that the provision of point-of-care testing played in participants willingness to participate [ 33 ].…”

“…Negative interactions with healthcare workers, lack of anonymity within HIV services, and perceived or actual experiences of HIV-related stigma and discrimination inhibited participant’s willingness to remain engaged in HIV care [ 11 , 24 – 27 , 39 ]. It was the absence of these barriers that participants in the qualitative study identified as important in influencing their participation in the larger biobehavioural survey – Kauntim mi tu [ 33 ]. When participants experienced barriers at multiple socio-ecological levels (e.g., stigma and discrimination from family, peers and health workers due to HIV positive status and/or sexuality/job) HIV treatment uptake and adherence was particularly challenging.…”

“…Second, changes at the institutional levels within health care services are required. For instance, anonymous, flexible, client-friendly HIV services tailored to the unique needs of key populations in PNG could improve ART initiation and adherence, as highlighted elsewhere [ 33 ]. Providing support and training in these areas for existing and new health service staff could help prevent poor service experiences, avoid the chance of stigmatising interactions between service providers and clients, and improve the interpersonal relationships between clients and service users.…”

Pacific Women, HIV, and Me: A Positioned Critical Poetic Inquiry

“…For women whose livelihoods are made through “survival sex,” their sex-selling story often starts right at their beginning, seized in the circumstances of their childhood. The next poem is a narrative poem, a story in poetry (Richardson, 1997), that I wrote while analyzing interviews with women who sell and exchange sex for goods (Kelly-Hanku et al, 2020). Life’s story is not always shiny.…”

Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda

“…In Uganda, community-based testing through moonlight outreach campaigns to key populations is the primary approach for promoting STI and HIV screening among FSW [ 22 , 23 ]. However, this approach is not well utilized by FSW due to the limited services offered (HIV testing, health education, and condom distribution), and lack of privacy and confidentiality [ 24 , 25 ]. Text message reminders offer an opportunity to promote frequent (i.e., more than yearly) HIV testing in line with WHO guidance for HIV and other STI screening.…”