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. 2018 Nov 1;13(11):e0205056.
doi: 10.1371/journal.pone.0205056. eCollection 2018.

Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation

Parinita Bhattacharjee  1 , Helgar Musyoki  2 , Ravi Prakash  3 , Serah Malaba  4 , Gina Dallabetta  5 , Tisha Wheeler  6 , Stephen Moses  1 , Shajy Isac  1 , Richard Steen  7
Affiliations

Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation

Parinita Bhattacharjee et al. PLoS One. .

Abstract

Peer education with micro-planning has been integral to scaling up key population (KP) HIV/STI programmes in Kenya since 2013. Micro-planning reinforces community cohesion within peer networks and standardizes programme inputs, processes and targets for outreach, including peer educator (PE) workloads. We assessed programme performance for outreach-in relation to the mean number of KPs for which one PE is responsible (KP:PE ratio)-and effects on HIV/STI service utilisation. Quarterly programmatic monitoring data were analysed from October 2013 to September 2016 from implementing partners working with female sex workers (FSWs) and men who have sex with men (MSM) across the country. All implementing partners are expected to follow national guidelines and receive micro-planning training for PEs with support from a Technical Support Unit for KP programmes. We examined correlations between KP:PE ratios and regular outreach contacts, condom distribution, risk reduction counselling, STI screening, HIV testing and violence reporting by KPs. Kenya conducted population size estimates (PSEs) of KPs in 2012. From 2013 to 2016, KP programmes were scaled up to reach 85% of FSWs (PSE 133,675) and 90% of MSM (PSE 18,460). Overall, mean KP:PE ratios decreased from 147 to 91 for FSWs, and from 79 to 58 for MSM. Lower KP:PE ratios, up to 90:1 for FSW and 60:1 for MSM, were significantly associated with more regular outreach contacts (p<0.001), as well as more frequent risk reduction counselling (p<0.001), STI screening (p<0.001) and HIV testing (p<0.001). Condom distribution and reporting of violence by KPs did not differ significantly between the two groups over all time periods. Micro-planning with adequate KP:PE ratios is an effective approach to scaling up HIV prevention programmes among KPs, resulting in high levels of programme uptake and service utilisation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Micro-planning boosted cascade model for key populations.
Abbreviations: KP: Key Populations, RMC: Regular Medical Checkup, HTC: HIV Testing and Counselling, ART: Anti-retroviral Therapy, VL: Viral load.
Fig 2
Fig 2. Quarterly outreach contacts, population size estimates and donor targets (31 FSW counties and 24 MSM counties).
Abbreviations: FSW: Female sex workers, MSM: men who have sex with men [30].
Fig 3
Fig 3. Regular outreach contacts and PE:KP ratio (22 FSW counties and 18 MSM counties).
Abbreviations: FSW: Female sex workers, MSM: Men who have sex with men, KP: Key Populations, PE: Peer educator [30].
Fig 4
Fig 4. Regular outreach contacts and service utilisation by PE:KP ratio (22 FSW counties).
Abbreviations: KP: Key Populations, PE: Peer educator, STI: Sexually transmitted infections, HIV: Human immune deficiency virus [30].
Fig 5
Fig 5. Regular outreach contacts and service utilisation by PE:KP ratio (18 MSM counties).
Abbreviations: KP: Key Populations, PE: Peer educator, STI: Sexually transmitted infections, HIV: Human immune deficiency virus [30].
See this image and copyright information in PMC

References

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