TY - JOUR
T1 - Reproductive health services for populations at high risk of HIV
T2 - Performance of a night clinic in Tete province, Mozambique
AU - Lafort, Yves
AU - Geelhoed, Diederike
AU - Cumba, Luisa
AU - Lzaro, Carla Das Dores Mosse
AU - Delva, Wim
AU - Luchters, Stanley
AU - Temmerman, Marleen
N1 - Funding Information:
In 2001, in Northern Mozambique, along the 'Tete corridor' connecting Zimbabwe with Malawi, a 'night clinic' was established specifically targeting FSW and LDD. The clinic is located near a major truck stop, 20 km from the provincial capital Tete, at the edge of Moatize town, and opens at a time considered convenient for the target populations (4-10 PM). Initially the clinic offered STI care and information, education and communication (IEC) on HIV/STI. In a subsequent phase, services were expanded to include contraceptive services and voluntary testing and counselling for HIV and syphilis. A group of 20 peer educators were trained in behaviour change communication and condom distribution. All services are free of charge. The clinic currently operates with health staff and medical supplies from the public sector, with financial and technical support from the International Centre for Reproductive Health (ICRH) in the context of a project funded by the Flemish International Cooperation Agency.
PY - 2010
Y1 - 2010
N2 - Background. Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. Methods. In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed. Results. An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times. Conclusions. Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.
AB - Background. Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. Methods. In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed. Results. An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times. Conclusions. Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.
UR - https://www.scopus.com/pages/publications/77953814667
U2 - 10.1186/1472-6963-10-144
DO - 10.1186/1472-6963-10-144
M3 - Article
C2 - 20507644
AN - SCOPUS:77953814667
SN - 1472-6963
VL - 10
JO - BMC Health Services Research
JF - BMC Health Services Research
M1 - 144
ER -
SDG 3 Good Health and Well-being