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Abstract：
Female sex workers in sub-Saharan Africa face high unmet need for family planning and higher risk for unintended pregnancy. Community empowerment HIV prevention approaches have the potential to increase family planning uptake and present an opportunity to integrate HIV, reproductive health, and contraception. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use.
This study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.) RESULTS: Among the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02-1.56]) and 36% (aRR 1.36 [95%CI: 1.13-1.64) higher than among those who had not attended.
There is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.
This study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.) RESULTS: Among the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02-1.56]) and 36% (aRR 1.36 [95%CI: 1.13-1.64) higher than among those who had not attended.
There is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.
摘要：
撒哈拉以南非洲的女性性工作者面临着高度未满足的计划生育需求和更高的意外怀孕风险。社区赋权艾滋病毒预防方法有可能增加对计划生育的采用，并为整合艾滋病毒提供机会，生殖健康,和避孕。本文介绍了Iringa女性性工作者的计划生育使用和怀孕情况，坦桑尼亚并评估参与社区赋权艾滋病毒预防计划是否与避孕药具使用有关。
本研究包括经过18个月的纵向队列研究的两个社区随机对照试验的二次分析。我们实施了为期一年的社区赋权干预，包括1）社区主导的中心下降；2）基于场地的同伴教育，避孕套分发，和艾滋病毒检测；3）同行服务导航；4）提供者和警察的敏感性培训；5）促进参与的短信。此外,每月的研讨会都在中心举行，其中之一是计划生育。使用改进的Poisson回归模型来估计干预组中程序暴露与计划生育使用之间的关联。（试验注册NCT02281578，2014年11月2日。)结果：在有计划生育随访数据的339名参与者中，60％报告目前使用计划生育；6％报告双重使用现代避孕和避孕套；超过90％的人有活着的孩子；85％的人在最近一次怀孕时寻求产前护理。在干预机构的185名参与者中，报告曾参加过Shikamana中心救助的女性性工作者和报告曾参加过计划生育相关研讨会的女性性工作者中,调整后使用计划生育的相对风险(aRR)分别为26%(aRR1.26[95%置信区间(CI):1.02-1.56])和36%(aRR1.36[95CI:1.13-1.64).
在这些人群中显然需要计划生育。一般计划的接触和计划生育讲习班的接触与较高的计划生育使用率有关，这表明社区赋权模型有可能增加这一弱势群体的计划生育。
本研究包括经过18个月的纵向队列研究的两个社区随机对照试验的二次分析。我们实施了为期一年的社区赋权干预，包括1）社区主导的中心下降；2）基于场地的同伴教育，避孕套分发，和艾滋病毒检测；3）同行服务导航；4）提供者和警察的敏感性培训；5）促进参与的短信。此外,每月的研讨会都在中心举行，其中之一是计划生育。使用改进的Poisson回归模型来估计干预组中程序暴露与计划生育使用之间的关联。（试验注册NCT02281578，2014年11月2日。)结果：在有计划生育随访数据的339名参与者中，60％报告目前使用计划生育；6％报告双重使用现代避孕和避孕套；超过90％的人有活着的孩子；85％的人在最近一次怀孕时寻求产前护理。在干预机构的185名参与者中，报告曾参加过Shikamana中心救助的女性性工作者和报告曾参加过计划生育相关研讨会的女性性工作者中,调整后使用计划生育的相对风险(aRR)分别为26%(aRR1.26[95%置信区间(CI):1.02-1.56])和36%(aRR1.36[95CI:1.13-1.64).
在这些人群中显然需要计划生育。一般计划的接触和计划生育讲习班的接触与较高的计划生育使用率有关，这表明社区赋权模型有可能增加这一弱势群体的计划生育。
