Extended working hours increase linkage to ART services among key populations in Kilimanjaro region


BACKGROUND: Tanzania's linkage to antiretroviral therapy (ART) services remains low among men who have sex with men (MSM) and female sex workers (FSWs). MSM and FSWs feel insecure about accessing highly visible ART clinics and find standard facility hours inconvenient. Health care workers (HCWs) are perceived as unaccepting, and criminalization of MSM and FSWs in the community leads to low use of traditional facilities. Traditional approaches to enhance service quality, including HCW counseling, peer navigation, and escorted referrals, have not been successful. The Meeting Targets and Maintaining Epidemic Control (EpiC) project introduced HCW engagement and extended working hours to complement linkage to ART services among key populations.
DESCRIPTION: Through routine client feedback, extended clinic hours were identified as a way to better meet the needs of FSWs and MSM. An assessment was conducted in 14 care and treatment center (CTC) sites in Kilimanjaro to determine feasibility of extending opening hours to improve linkage to ART services. EpiC began an incentive system offering CTC nurses transport reimbursement for working during extended hours (before 7 a.m. or after 3 p.m. on weekdays, or on a weekend). EpiC trained 19 HCWs from 19 health facilities on key-population-friendly services during extended working hours.
Linkage rates increased from 82% to 99% among FSWs and MSM after the introduction of extended working hours and HCW training on the provision of key-population-friendly services. Extended working hours may better meet the needs of key populations and enhance linkage rates among populations that are traditionally difficult to reach.
CONCLUSIONS: There should be a scale-up of key-population-friendly services during extended clinic hours to all EpiC regions to increase linkage among FSWs and MSM. These interventions are simple to implement and could be tested among other populations to accelerate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 goals.

Download the e-Poster (PDF)