Delivering integrated HIV/modern family planning services to female sex workers through mobile, community-based, integrated biomedical services in five regions of Tanzania

Background: Unplanned pregnancies are an occupational hazard for female sex workers (FSW) who infrequently access the health system due to fear of stigma and discrimination and the criminalization of sex work. Key population-friendly mobile community-based HIV testing and counseling “plus” (CBHTC+) teams operated by the PEPFAR-funded Sauti Program provide family planning (FP) counseling and services integrated with HIV testing and counseling, and STI, TB, gender-based violence, and alcohol and drug screening in hotspots in five regions of Tanzania. This abstract describes the uptake of FP services by FSW in this program.
Description: Patient level data was collected during CBHTC+ services, entered into a central database through single data entry, cleaned and analyzed using STATA statistical software. Chi2 test compared proportions and logistic regression assessed associations.
Lessons learned: Between August and December 2015, records were entered for 9,332 females reached through the Sauti program, of which 30% (n= 2,712) identified as FSW (median 28 years [IQR 24-33]). More than one third (36%, n=967) of this population had had previous experience with contraception, mainly using injectables (52% n=503) followed by implants (22%, n=217) and oral contraceptives (17%, n=165). Two percent (n=22) had used an intrauterine device before, and 1% (n=13) reported tubal ligation. At the time they accessed Sauti services, only 22% (n=592) were currently using FP, with a similar distribution of methods. Following their visit to Sauti, 13% (n=357) newly initiated FP, preferring implants (17%, n= 86) over injectables (15%, n=74) and pills (7%, n=34) besides male condoms (52%, n=257). Younger age and previous experience with FP was associated with FP uptake (OR 0.98, p= 0.011: OR 2.3, p< 0.001 respectively).
Conclusions/Next steps: FSW, especially younger FSW, have an unmet need for modern FP methods which can be addressed through easily accessible and non-judgmental FP services. Injectables were the most common FP method in the population, but when choosing in the KP-friendly supportive counseling environment of the Sauti Program, next to male condoms, FSW chose implants over injectables; suggesting a subgroup of FSW who have existing interest in long term FP. Programs learn more about the fertility intentions of FSW to help further shape the FP counselling.

C. Casalini1, J. Basomingera2, T. Lennemann1, D. Boyee1, A. Komba1, J. Schueller3, H. Mahler1
1Jhpiego, Program, Dar es Salaam, Tanzania, United Republic of, 2Engenderhealth, Dar es Salaam, Tanzania, United Republic of, 3USAID, Dar es Salaam, Tanzania, United Republic of