Assessing the Impact of Peer Educator Outreach on the Likelihood and Acceleration of Clinic Utilization among Sex Workers.
Assessing the Impact of Peer Educator Outreach on the Likelihood and Acceleration of Clinic Utilization among Sex Workers.
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DOI：
10.1371/journal.pone.0159656
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Pushpalatha R
中科院分区：
文献类型：
--
作者：
Krishnamurthy P;Hui SK;Shivkumar N;Gowda C;Pushpalatha R
同伴带头的外展是对待性工作者的艾滋病毒和减少性传播感染干预措施的一个关键要素。我们研究性工作者同伴带头接触与利用卫生设施及时发现和治疗性传播感染症状的时间之间的联系。利用同伴外展干预的时间和诊所就诊的数据，我们利用扩展的考克斯模型来评估同伴教育者的外展强度是否与性工作者加速的诊所利用有关。我们的数据来自2705名注册到Pragati的女性性工作者，这是一个女性在性工作中的外展项目，从2008年到2012年进行了跟踪调查。我们使用扩展的COX模型分析了这些数据，以30天滚动窗口中同伴教育者的访问密度作为关键预测因素，同时控制了性工作者的年龄、客户数量、性工作地点和教育水平。令人感兴趣的主要结果是第一次自愿使用临床的时间。更频繁的同伴就诊与较早的首次就诊有关(HR：1.83，95%CI，1.75-1.91，P<；.001)。此外，检测到的所有基于症状的性传播感染中有18%来自就诊，性工作者在就诊时报告没有症状，这突显了诱导就诊在检测性传播感染中的重要性。测试这些发现的稳健性的其他模型表明，同伴教育者外展具有一致的有益效果。同伴外展密度与女性性工作者利用诊所的可能性增加和持续时间缩短有关，这表明潜在的工作人员资源问题。然而，考虑到我们研究的观察性，这些发现应该被解释为一种联系，而不是因果关系。
Peer-led outreach is a critical element of HIV and STI-reduction interventions aimed at sex workers. We study the association between peer-led outreach to sex workers and the time to utilize health facilities for timely STI syndromic-detection and treatment. Using data on the timing of peer-outreach interventions and clinic visits, we utilize an Extended Cox model to assess whether peer educator outreach intensity is associated with accelerated clinic utilization among sex workers. Our data comes from 2705 female sex workers registered into Pragati, a women-in-sex-work outreach program, and followed from 2008 through 2012. We analyze this data using an Extended Cox model with the density of peer educator visits in a 30-day rolling window as the key predictor, while controlling for the sex workers’ age, client volume, location of sex work, and education level. The principal outcome of interest is the timing of the first voluntary clinic utilization. More frequent peer visit is associated with earlier first clinic visit (HR: 1.83, 95% CI, 1.75–1.91, p < .001). In addition, 18% of all syndrome-based STI detected come from clinic visits in which the sex worker reports no symptoms, underscoring the importance of inducing clinic visits in the detection of STI. Additional models to test the robustness of these findings indicate consistent beneficial effect of peer educator outreach. Peer outreach density is associated with increased likelihood of–and shortened duration to–clinic utilization among female sex workers, suggesting potential staff resourcing implications. Given the observational nature of our study, however, these findings should be interpreted as an association rather than as a causal relationship.