Reaching the Unreachable: Providing STI Control Services to Female Sex Workers via Mobile Team Outreach

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.

STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11

“…Alternatively, the observed proportion of positive HIV tests may have been low since we only assessed test results from FSW attending LPHD. FSW who do not have any access to health care may have a higher HIV prevalence as suggested by findings in Peru [23]. In the Netherlands, Verscheijden et al observed a lower STI prevalence during outreach activities than at STI clinics, but this may explained by the fact that outreach activities mainly targeted FSW working in legal establishments [19, 23].…”

Barriers to Cervical Screening Among Sex Workers in Vancouver

“…40 In Peru, a community-based intervention providing mobile services found that such services increased condom use and reduced sexually transmitted infection prevalence, including among sex workers typically not reached by government-operated services. 41 Other innovative models include health care services run by and for sex workers, such as at St. James Infirmary in San Francisco, California. 42 The St. James Infirmary model of care has been highly successful in providing confidential and nonjudgmental sexual health services for sex workers.…”

Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru

“…Outcome surveys were performed at the city-level and enrolled FSW separately from the intervention, thus one quarter of the women completing outcome surveys in the intervention cities had not participated in the intervention. Furthermore, the mobile teams reported high turn-over among participants; after the fifth cycle of the intervention, more than half of FSW were identified as first time participants (23). This is supported by consistent associations between increased health screening behaviors and reported exposure to the intervention.…”