Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
JMIR Public Health Surveill. 2022 Jul 27;8(7):e32286. doi: 10.2196/32286.
Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach.
We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services.
We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 "seed" participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services.
Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6% vs 930/5386, 17.3%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3% vs 243/930, 26.1%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8% vs 396/930, 42.6%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US $7.46 for peer outreach and US $52.81 for RDS.
Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-DOI 10.1186/s12889-018-5085-6.
年轻女性性工作者（YWSS）在获得艾滋病毒预防和护理服务方面服务不足。“决心、坚韧、赋权、艾滋病自由、指导和安全（DREAMS）”伙伴关系旨在减少撒哈拉以南非洲 10 个国家脆弱的青少年女孩和年轻女性群体（包括 YWSS）获得艾滋病毒的风险。我们描述了 2 种方法，即响应驱动抽样（RDS）和同伴外展，用于将 YWSS 转介到津巴布韦的 DREAMS 服务，并比较了通过每种方法转介的 YWSS 的特征和参与情况。我们假设 RDS 将确定处于 HIV 高风险的 YWSS 以及那些与 HIV 预防和护理服务的参与程度低于同伴外展的 YWSS。
我们旨在比较响应驱动抽样和同伴外展在招募和转介高危人群接受 HIV 预防和护理服务方面的效果。
我们分别使用 RDS（一种旨在接触关键人群网络的代表性样本的抽样方法）和同伴外展（一种识别、接触和转介 YWSS 参加 DREAMS 的方案方法），于 2017 年 4 月至 7 月和 2017 年 1 月至 7 月在津巴布韦的 2 个城市招募和转介 YWSS。对于 RDS，我们进行了详细的地图绘制，以了解性工作的类型和地理分布，然后有目的地在每个城市选择 10 名“种子”参与者来启动 RDS。对于同伴外展，我们通过 18 名经过培训和年龄匹配的同伴教育者使用针对青年的社区动员来启动招募。我们描述了通过每种转介方法获得 DREAMS 服务的 YWSS 的特征和服务参与情况，并使用卡方检验评估这些特征与转介方法之间的关联。分析时分别在包含和不包含 RDS 进行的时间段内进行。我们估计了使用每种策略招募 YWSS 以转介到 DREAMS 服务的相对增量成本。
总体而言，通过同伴外展和 RDS 分别为 5386 名和 1204 名 YWSS 转介到 DREAMS 服务。与通过同伴外展转介的 YWSS 相比，通过 RDS 转介的 YWSS 更有可能获得 DREAMS 服务（501/1204，41.6% vs 930/5386，17.3%；P<.001）。无论转介方法如何，获得 DREAMS 服务的 YWSS 具有相似的教育水平，并且同样比例的人 HIV 检测呈阴性，并报告在最近一次性行为中未使用安全套。通过 RDS 获得 DREAMS 服务的 YWSS 中，年龄在 18-19 岁的比例更高（167/501，33.3% vs 243/930，26.1%；P=.004），并且更有可能了解自己的 HIV 状况（395/501，78.8% vs 396/930，42.6%；P<.001），与通过同伴外展获得 DREAMS 服务的 YWSS 相比。招募的每个年轻女性性工作者的增量成本为同伴外展 7.46 美元，RDS 为 52.81 美元。
同伴外展和 RDS 方法可以接触和转介高危但不同群体的 YWSS 接受艾滋病毒服务，并且使用这两种方法可能会提高接触率。
