Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: A systematic review

Soori Nnko, Evodius Kuringe, Daniel Nyato, Mary Drake, Caterina Casalini, Amani Shao, Albert Komba, Stefan Baral, Mwita Wambura, John Changalucha

Research output: Contribution to journalArticle

Abstract

Background: HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. Methods: A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. Results: This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. Conclusions: FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.

Original languageEnglish (US)
Article number15
JournalBMC Public Health
Volume19
Issue number1
DOIs
StatePublished - Jan 5 2019

Fingerprint

Sex Workers
Africa South of the Sahara
Counseling
HIV
Sex Work
Continuity of Patient Care

Keywords

  • Access
  • Determinants
  • Female sex workers
  • HIV testing and counselling
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa : A systematic review. / Nnko, Soori; Kuringe, Evodius; Nyato, Daniel; Drake, Mary; Casalini, Caterina; Shao, Amani; Komba, Albert; Baral, Stefan; Wambura, Mwita; Changalucha, John.

In: BMC Public Health, Vol. 19, No. 1, 15, 05.01.2019.

Research output: Contribution to journalArticle

Nnko, S, Kuringe, E, Nyato, D, Drake, M, Casalini, C, Shao, A, Komba, A, Baral, S, Wambura, M & Changalucha, J 2019, 'Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: A systematic review', BMC Public Health, vol. 19, no. 1, 15. https://doi.org/10.1186/s12889-018-6362-0
Nnko, Soori ; Kuringe, Evodius ; Nyato, Daniel ; Drake, Mary ; Casalini, Caterina ; Shao, Amani ; Komba, Albert ; Baral, Stefan ; Wambura, Mwita ; Changalucha, John. / Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa : A systematic review. In: BMC Public Health. 2019 ; Vol. 19, No. 1.
@article{0efd3e0f391545b49d5fa866ee558b04,
title = "Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: A systematic review",
abstract = "Background: HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. Methods: A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. Results: This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. Conclusions: FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.",
keywords = "Access, Determinants, Female sex workers, HIV testing and counselling, Sub-Saharan Africa",
author = "Soori Nnko and Evodius Kuringe and Daniel Nyato and Mary Drake and Caterina Casalini and Amani Shao and Albert Komba and Stefan Baral and Mwita Wambura and John Changalucha",
year = "2019",
month = "1",
day = "5",
doi = "10.1186/s12889-018-6362-0",
language = "English (US)",
volume = "19",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa

T2 - A systematic review

AU - Nnko, Soori

AU - Kuringe, Evodius

AU - Nyato, Daniel

AU - Drake, Mary

AU - Casalini, Caterina

AU - Shao, Amani

AU - Komba, Albert

AU - Baral, Stefan

AU - Wambura, Mwita

AU - Changalucha, John

PY - 2019/1/5

Y1 - 2019/1/5

N2 - Background: HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. Methods: A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. Results: This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. Conclusions: FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.

AB - Background: HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. Methods: A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. Results: This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. Conclusions: FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.

KW - Access

KW - Determinants

KW - Female sex workers

KW - HIV testing and counselling

KW - Sub-Saharan Africa

UR - http://www.scopus.com/inward/record.url?scp=85059494408&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059494408&partnerID=8YFLogxK

U2 - 10.1186/s12889-018-6362-0

DO - 10.1186/s12889-018-6362-0

M3 - Article

C2 - 30611219

AN - SCOPUS:85059494408

VL - 19

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 15

ER -