Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya
Abstract Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00516-x |
| _version_ | 1797454010350829568 |
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| author | Amanda Poxon Maria Leis Miranda McDermott Antony Kariri Rupert Kaul Joshua Kimani |
| author_facet | Amanda Poxon Maria Leis Miranda McDermott Antony Kariri Rupert Kaul Joshua Kimani |
| author_sort | Amanda Poxon |
| collection | DOAJ |
| description | Abstract Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. Methods An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. Results Of the total 220 women (median [IQR] age 32 [27–39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64–2.94], p < 0.01), PrEP use (OR 1.54 (1.25–1.91), < 0.01), and client HIV status (OR 1.35 (1.02–1.69), p < 0.01). Conclusions Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED’s. |
| first_indexed | 2024-03-09T15:31:05Z |
| format | Article |
| id | doaj.art-456c413f57aa45139bf755a22ba6cf78 |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-03-09T15:31:05Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-456c413f57aa45139bf755a22ba6cf782023-11-26T12:14:59ZengBMCInternational Journal of Emergency Medicine1865-13802023-08-0116111010.1186/s12245-023-00516-xEmergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, KenyaAmanda Poxon0Maria Leis1Miranda McDermott2Antony Kariri3Rupert Kaul4Joshua Kimani5Department of Medicine, University of Toronto, 1 King’s College CircleDepartment of Medicine, University of Toronto, 1 King’s College CircleDepartment of Medicine, University of Toronto, 1 King’s College CircleDepartment of Medical Microbiology, University of NairobiDepartment of Medicine, University of Toronto, 1 King’s College CircleDepartment of Medical Microbiology, University of NairobiAbstract Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. Methods An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. Results Of the total 220 women (median [IQR] age 32 [27–39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64–2.94], p < 0.01), PrEP use (OR 1.54 (1.25–1.91), < 0.01), and client HIV status (OR 1.35 (1.02–1.69), p < 0.01). Conclusions Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED’s.https://doi.org/10.1186/s12245-023-00516-xFemale sex workersEmergency medicineAcute careHIV |
| spellingShingle | Amanda Poxon Maria Leis Miranda McDermott Antony Kariri Rupert Kaul Joshua Kimani Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya International Journal of Emergency Medicine Female sex workers Emergency medicine Acute care HIV |
| title | Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya |
| title_full | Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya |
| title_fullStr | Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya |
| title_full_unstemmed | Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya |
| title_short | Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya |
| title_sort | emergency departments as under utilized venues to provide hiv prevention services to female sex workers in nairobi kenya |
| topic | Female sex workers Emergency medicine Acute care HIV |
| url | https://doi.org/10.1186/s12245-023-00516-x |
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