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Epidemiology
Original article
Key Programme Science lessons from an HIV prevention ‘Learning Site’ for sex workers in Mombasa, Kenya
  1. Leigh M McClarty1,
  2. Parinita Bhattacharjee1,
  3. Shajy Isac1,
  4. Faran Emmanuel1,
  5. Japheth Kioko2,3,
  6. Margaret Njiraini3,
  7. Peter Gichangi4,
  8. Clifford Duncan Okoth5,
  9. Janet Musimbi-Mbole3,
  10. James F Blanchard1,
  11. Stephen Moses1,
  12. Helgar Muysyoki2,
  13. Marissa L Becker1
  1. 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
  3. 3 Partners for Health and Development in Africa, Nairobi, Kenya
  4. 4 International Centre for Reproductive Health Kenya, Mombasa, Kenya
  5. 5 Community Advisory Board, Learning Site, Mombasa, Kenya
  1. Correspondence to Leigh M McClarty, Department of Community Health Sciences, Centre for Global Public Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0T6, Canada; ummcclar{at}myumanitoba.ca

Abstract

Objectives In 2013, Kenya’s National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring.

Methods Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County.

Results Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers.

Conclusion Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, ‘on-the-ground’ realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time.

  • Africa
  • prevention
  • commercial Sex
  • programme science

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/sextrans-2017-053228

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    Footnotes

    • Handling editor Jackie A Cassell

    • Contributors LMM analysed and interpreted the data and wrote the article. PB contributed to programme design and implementation, data acquisition, interpretation of results, and reviewed the article. SI contributed to data analysis and interpretation of results. FE contributed to interpretation of results. JK and MN contributed to programme monitoring and data acquisition. PG contributed to programme implementation. CDO contributed to programme design, implementation, and monitoring, as well as data acquisition. JM-M contributed to programme design and monitoring. JFB and SM conceived of and designed the programme, and critically reviewed the article. HM contributed to programme design and implementation. MLB contributed to data analysis, interpreted results and critically reviewed the article. All authors approved the final manuscript.

    • Funding This study was funded by Bill and Melinda Gates Foundation, 10.13039/100000865, grant number (OPP1032367).

    • Competing interests None declared.

    • Ethics approval Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (reference no. KNH-ERC/A/443).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Programme monitoring data from the Mombasa Learning Site may be made available to interested researchers upon request to the University of Manitoba’s Centre for Global Public Health (cgph@umanitoba.ca).