肯尼亚规模性关键人群微观规划:优化同伴教育者比例,以扩大项目覆盖面并增加 HIV/性传播感染服务的利用。

Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation.

机构信息

Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.

National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya.

出版信息

PLoS One. 2018 Nov 1;13(11):e0205056. doi: 10.1371/journal.pone.0205056. eCollection 2018.

Abstract

Peer education with micro-planning has been integral to scaling up key population (KP) HIV/STI programmes in Kenya since 2013. Micro-planning reinforces community cohesion within peer networks and standardizes programme inputs, processes and targets for outreach, including peer educator (PE) workloads. We assessed programme performance for outreach-in relation to the mean number of KPs for which one PE is responsible (KP:PE ratio)-and effects on HIV/STI service utilisation. Quarterly programmatic monitoring data were analysed from October 2013 to September 2016 from implementing partners working with female sex workers (FSWs) and men who have sex with men (MSM) across the country. All implementing partners are expected to follow national guidelines and receive micro-planning training for PEs with support from a Technical Support Unit for KP programmes. We examined correlations between KP:PE ratios and regular outreach contacts, condom distribution, risk reduction counselling, STI screening, HIV testing and violence reporting by KPs. Kenya conducted population size estimates (PSEs) of KPs in 2012. From 2013 to 2016, KP programmes were scaled up to reach 85% of FSWs (PSE 133,675) and 90% of MSM (PSE 18,460). Overall, mean KP:PE ratios decreased from 147 to 91 for FSWs, and from 79 to 58 for MSM. Lower KP:PE ratios, up to 90:1 for FSW and 60:1 for MSM, were significantly associated with more regular outreach contacts (p<0.001), as well as more frequent risk reduction counselling (p<0.001), STI screening (p<0.001) and HIV testing (p<0.001). Condom distribution and reporting of violence by KPs did not differ significantly between the two groups over all time periods. Micro-planning with adequate KP:PE ratios is an effective approach to scaling up HIV prevention programmes among KPs, resulting in high levels of programme uptake and service utilisation.

摘要

同伴教育与微观规划自 2013 年以来一直是肯尼亚扩大重点人群(KP)艾滋病毒/性传播感染方案的重要组成部分。微观规划加强了同伴网络中的社区凝聚力,并为外展工作标准化了方案投入、流程和目标,包括同伴教育者(PE)的工作量。我们评估了外展工作的方案绩效——与一名 PE 负责的重点人群数量(KP:PE 比例)有关——以及对艾滋病毒/性传播感染服务利用的影响。2013 年 10 月至 2016 年 9 月,从全国范围内与女性性工作者(FSW)和男男性行为者(MSM)合作的实施伙伴处收集了季度方案监测数据。所有实施伙伴都预计将遵循国家准则,并在重点人群方案技术支持股的支持下接受同伴教育者微观规划培训。我们研究了 KP:PE 比例与常规外展接触、安全套发放、减少风险咨询、性传播感染筛查、艾滋病毒检测和重点人群报告暴力行为之间的相关性。肯尼亚于 2012 年对重点人群进行了人口规模估计(PSE)。2013 年至 2016 年期间,重点人群方案规模扩大到覆盖 85%的 FSW(PSE 133,675)和 90%的 MSM(PSE 18,460)。总体而言,FSW 的平均 KP:PE 比例从 147 下降到 91,MSM 的比例从 79 下降到 58。直到 FSW 达到 90:1 和 MSM 达到 60:1 的较低 KP:PE 比例与更频繁的常规外展接触(p<0.001)以及更频繁的减少风险咨询(p<0.001)、性传播感染筛查(p<0.001)和艾滋病毒检测(p<0.001)显著相关。在所有时间段内,KP 安全套发放和暴力报告在两组之间均无显著差异。有足够 KP:PE 比例的微观规划是扩大重点人群艾滋病毒预防方案的有效方法,可带来高水平的方案参与和服务利用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3f1/6211676/89757db78f0a/pone.0205056.g001.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索