Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India

• Published in: PloS one 2019-06, Vol.14 (6), p.e0218654-e0218654
• Main Authors: Reza-Paul, Sushena, Lazarus, Lisa, Maiya, Raviprakash, Venukumar, K T, Lakshmi, Bhagya, Roy, Anuradha, Haldar, Partha, Andina, Michele, Lafort, Yves, Lorway, Robert
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Ambulatory Care Facilities - organization & administration; Ambulatory Care Facilities - statistics & numerical data; Analysis; Biology and Life Sciences; Cancer screening; Cervical cancer; Cervix; Communities; Community Health Services - methods; Community Health Services - organization & administration; Community Health Services - statistics & numerical data; Condoms; Cross-Sectional Studies; Delivery of Health Care - methods; Delivery of Health Care - organization & administration; Delivery of Health Care - statistics & numerical data; Developing countries; Disease prevention; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Evaluation; Family Planning Services - methods; Family Planning Services - organization & administration; Family Planning Services - statistics & numerical data; Female; Focus Groups; Health aspects; Health care; Health care industry; Health sciences; Health services; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; HIV patients; HIV tests; Human immunodeficiency virus; Humans; India - epidemiology; Infection Control - methods; Infection Control - organization & administration; Intervention; LDCs; Male; Maternal & child health; Medical screening; Medicine; Medicine and Health Sciences; Middle Aged; Mixed methods research; Occupational health; Patient Acceptance of Health Care - statistics & numerical data; People and Places; Population; Pregnancy; Prevention; Program Evaluation; Prostitutes; Prostitution; Public health; Quality of Health Care - standards; Reproduction; Reproductive health; Reproductive Health Services - organization & administration; Reproductive Health Services - statistics & numerical data; Reproductive systems; Safe Sex - psychology; Safe Sex - statistics & numerical data; Scaling; Scaling up; Sex; Sex industry; Sex oriented businesses; Sex Workers - psychology; Sex Workers - statistics & numerical data; Sexually transmitted diseases; Sexually Transmitted Diseases - diagnosis; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; Social Sciences; Statistical analysis; STD; Strategy; Surveys and Questionnaires; Transgender persons; Transgender Persons - statistics & numerical data; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - prevention & control; Womens health; Workers; Working women; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0218654

Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012-13) and end of project (2015-16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013-2016. The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p