P1-S2.12 Improving access to STI care among female sex workers by strengthening service provider networks in Bangalore, South India

Abstract

Background: The Karnataka Health Promotion Trust, in partnership with non-governmental and community-based organisations, has been implementing a focused HIV prevention project among female sex workers (FSWs) in Bangalore since 2005. Over 25 000 distinct female sex workers have been contacted to date, and approximately 10 000 distinct FSWs are regularly contacted each month. The majority of FSWs are street-based and home-based, and are dispersed throughout the city. In the first 3 years of the project, STI services were provided through eight program-linked clinics located in program drop-in-centres, and 20 external referral doctors. Discussions with FSWs indicated that distance and inconvenient timings of the clinics were major barriers to accessing STI services. A strategy was therefore developed in 2008 to expand the network of referral doctors. Referral doctor networks were established at sites based on recommendations made by FSWs, both in government facilities and in private clinics. A total of 70 referral doctors (preferred providers) were identified and trained to provide quality STI services. We evaluated the outcome of this changed strategy. Methods: Indicators related to STI services provided and their accessibility were extracted from the program's computerised management information system (CMIS). Results: Following the change in strategy, average monthly clinic visits by FSWs increased from 16% to 28% of the total available population. Quarterly clinic visits increased from 41% in 2008 to 63% in 2010. Administration of presumptive STI treatment for newly identified FSWs increased from 35% in 2008 to 58% in 2010. Focus group discussions with FSWs indicated that they are more comfortable in accessing clinic services, as the preferred providers are closer to where they live and work, and are available at more convenient times, especially in the evenings. This resulted in the higher levels of service coverage. The sex workers also indicated that, although services currently are provided at no charge to them, they would continue to access them from the preferred providers if the project ended, even if they had to pay for the services. Conclusions: Establishing a network of referral doctors who have been identified and sanctioned by the FSW community has complemented program-linked STI clinic services in the context of a large-scale HIV prevention program in the city of Bangalore, and has made STI services more accessible.