Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya

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dc.contributor.authorPoxon, Amanda
dc.contributor.authorLeis, Maria
dc.contributor.authorMcDermott, Miranda
dc.contributor.authorKariri, Antony
dc.contributor.authorKaul, Rupert
dc.contributor.authorKimani, Joshua
dc.date.accessioned2023-11-14T20:05:45Z
dc.date.available2023-11-14T20:05:45Z
dc.date.issued2023-08-03
dc.date.updated2023-11-03T09:14:56Z
dc.description.abstractBackground 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.
dc.identifier.citationInternational Journal of Emergency Medicine. 2023 Aug 03;16(1):47
dc.identifier.doi10.1186/s12245-023-00516-x
dc.identifier.urihttp://hdl.handle.net/1993/37785
dc.language.isoeng
dc.language.rfc3066en
dc.publisherBMC
dc.rightsopen accessen_US
dc.rights.holderSpringer-Verlag GmbH Germany, part of Springer Nature
dc.subjectFemale sex workers
dc.subjectEmergency medicine
dc.subjectacute care
dc.subjecthuman immunodeficiency virus
dc.subjectpost-exposure prophylaxis
dc.subjectpre-exposure prophylaxis
dc.titleEmergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya
dc.typeJournal Article
local.author.affiliationRady Faculty of Health Sciences::Max Rady College of Medicine::Department of Medical Microbiology and Infectious Diseases
oaire.citation.issue47
oaire.citation.titleInternational Journal of Emergency Medicine
oaire.citation.volume16
project.funder.identifierhttp://dx.doi.org/10.13039/501100003579
project.funder.nameUniversity of Toronto
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