Background: To achieve the fast track initiatives to end HIV/AIDS by 2030, World Health Organization and international community recommends accelerated technical and programmatic innovations. However, in sub Saharan Africa, particularly in Uganda, despite many governmental and non-governmental HIV Prevention interventions designed to increase health service uptake among key populations (Female sex workers (FSWs), Men having sex with men, people living with HIV etc), outcome results remain sub-optimal.
USAID''s RHITES-EC project under University Research co. LLC (URC); implemented HIV prevention interventions targeting FSWs through a cascade model of mentor-ship for mixed local cadre staff using outreaches. Though it was successful, little is known about the process and what characteristics of HIV Prevention outreach teams are essential for effective delivery of services among FSWs.
Description: HIV Prevalence in East central Uganda reduced from 5.8% in 2011 to 4.7% in 2017, however, the AIDS Assessment report 2017, indicated that high HIV positivity rates still existed among key populations with FSWs most affected. The project scaled up HIV prevention interventions targeting FSW between June to September 2017 prioritizing on-job mentor-ship of mixed cadre staff at all levels on the HIV Prevention minimum package followed by mentorships for HIV prevention outreach teams composed of FSW peers, Bio-medical staff, and community social workers. Contrary, previous HIV prevention programs relied only on medical staff from health facilities and Community Health workers (CHW) to mobilize FSWs.
Lessons learned: The number of female sex workers reached increased from 5.9% (n=311) in June to 72.4% (n=3828) in September 2017 with an HIV positivity rate of 8.0%. Linkage to care for new HIV positives increased from 55.2% in June to 78.7% in September 2017 among other services. The increase in services uptake was due to change in working with acceptable demand creation agents coupled with well supported mixed professionals at the supply end.
Conclusions/Next steps: The cascade model of mentorship for mixed cadres proved to be successful in improving health services uptake among FSWs; specific issues related to demand creation approaches, Human resources diversification and on-job support were highlighted for scale up and inform future HIV Prevention framework strategies.