“对角线”干预措施对莫桑比克女性性工作者性与生殖健康服务利用情况的影响：一项混合方法实施研究
Impact of a "Diagonal" Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study.
作者信息
Lafort Yves, Lessitala Faustino, Ismael de Melo Malica Sofia, Griffin Sally, Chersich Matthew, Delva Wim
机构信息
International Centre for Reproductive Health, Ghent University, Gent, Belgium.
International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
出版信息
Front Public Health. 2018 Apr 18;6:109. doi: 10.3389/fpubh.2018.00109. eCollection 2018.
BACKGROUND
Female sex workers (FSWs) have high risks for adverse sexual and reproductive health (SRH) outcomes, yet low access to services. Within an implementation research project enhancing uptake of SRH services by FSWs, we piloted a "diagonal" intervention, which combined strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal), and tested its effect.
METHODS
The study applied a convergent parallel mixed-methods design to assess changes in access to SRH services. Results of structured interviews with FSWs pre-intervention ( = 311) and thereafter ( = 404) were compared with the findings of eight post-intervention focus group discussions (FGDs) with FSWs and two with FSW-peer educators (PEs).
RESULTS
Marked and statistically significant rises occurred in consistent condom use with all partners (55.3-67.7%), ever use of female condoms (37.9-54.5%), being tested for HIV in the past 6 months (56.0-76.6%), using contraception (84.5-95.4%), ever screened for cervical cancer (0.0-16.9%) and having ≥10 contacts with a PE in the past year (0.5-24.45%). Increases mostly resulted from FSW-targeted outreach, with no rise detected in utilization of public health facilities. FGD participants reported that some facilities had become more FSW-friendly, but barriers such as stock-outs, being asked for bribes and disrespectful treatment persisted.
CONCLUSION
The combination of expanding FSW-targeted SRH services with improving access to the public health services resulted in an overall increased uptake of services, but almost exclusively because of the strengthened targeted (vertical) outreach services. Utilization of public SRH services had not yet increased and many barriers to access remained. Our diagonal approach was thus only successful in its vertical component. Improving access to the general health services remains nevertheless important and further research is needed how to reduce barriers. Ideally, the combination approach should be maintained and more successful approaches to increase utilization of public services should be explored.
背景
女性性工作者面临不良性健康和生殖健康（SRH）结局的高风险，但获得服务的机会却很低。在一个旨在提高女性性工作者对SRH服务利用率的实施研究项目中，我们试点了一种“对角线”干预措施，该措施将加强针对女性性工作者的服务（纵向）与使公共卫生设施对女性性工作者更友好（横向）相结合，并测试了其效果。
方法
该研究采用了收敛平行混合方法设计来评估获得SRH服务的变化。将干预前（n = 311）及之后（n = 404）对女性性工作者进行的结构化访谈结果与干预后与女性性工作者进行的八次焦点小组讨论（FGD）以及与女性性工作者同伴教育者（PE）进行的两次讨论结果进行比较。
结果
与所有性伴始终坚持使用避孕套（55.3% - 67.7%）、曾经使用女用避孕套（37.9% - 54.5%）、在过去6个月内进行过HIV检测（56.0% - 76.6%）、使用避孕措施（84.5% - 95.4%）、曾经接受过宫颈癌筛查（0.0% - 16.9%）以及在过去一年中与同伴教育者接触≥10次（0.5% - 24.45%）的情况均出现了显著且具有统计学意义的上升。增加主要源于针对女性性工作者的外展服务，公共卫生设施的利用率未出现上升。焦点小组讨论参与者报告称，一些设施对女性性工作者变得更友好了，但诸如缺货、被索要贿赂和受到不尊重对待等障碍仍然存在。
结论
扩大针对女性性工作者的SRH服务与改善获得公共卫生服务的机会相结合，总体上导致了服务利用率的提高，但几乎完全是由于加强了有针对性的（纵向）外展服务。公共SRH服务的利用率尚未提高，且仍存在许多获取障碍。因此，我们的对角线方法仅在其纵向部分取得了成功。然而，改善获得一般卫生服务的机会仍然很重要，需要进一步研究如何减少障碍。理想情况下，应维持这种组合方法，并探索更成功的提高公共服务利用率的方法。
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