Background: Higher prevalence of sexually transmitted infections (STI) and undiagnosed HIV infections are markers of suboptimal access to clinically competent and appropriate health care services and have a direct impact on health outcomes. Prevalence of HIV and STI among key populations (KP) remain higher than general population. To inform service provision efforts, we assessed the characteristics of HIV-positive KPs who were recruited through facility-based “one-stop-shops” (OSSs) and through community outreach activities.
Methods: Between January and July 2018, newly HIV diagnosed men who have sex with men (MSM) and female sex workers (FSWs) were recruited facility-based OSSs and community outreach activities in Lagos and Benue states. Baseline data on health service utilization and sexual risk behaviour were collected with the use of structured questionnaire and analyzed cross-sectionally. Proportions with chi-squared test was conducted to assess differences between categorical variables while logistic regression was used to assess associations with health service utilization.
Results: A total of 263 MSM and 342 FSWs newly HIV diagnosed clients were recruited into the study with 59% recruited via OSS and 41% via outreaches. Median age was 24 years for OSS clients compared to 27 years outreach clients. Over 90% of OSS clients had at least secondary level education compared to 63% for outreach clients. More OSS clients (89% vs. 49%; p< 0.0001) used lubricants during anal sex. History of STIs in last 6 months (45% vs. 20%; p< 0.001) and treatment of last STI episode (77% vs. 61%; p=0.008) was also higher among OSS clients. Controlling for age, education, and location, OSS clients were five times more likely than outreach clients to use lubricants (AOR:5.32;95%CI:2.11-13.39), and two times more likely (AOR:1.86; 95%CI: 1.12 - 3.06) to report STIs and treat the last episode of STI (AOR:2.07;95%CI:1.03-4.16).
Conclusions: Key populations recruited through the OSS facilities were younger, more educated and reported higher use of lubricants and treatment of STI symptoms than KPs recruited via outreach modalities. It is recommended that outreach services provide strengthened HIV prevention and STI services to bridge the inequality in health care utilization among KPs.