Evaluation of a Peer Education Program to Promote Family Planning Among Female Sex Workers in Kenya
Condition: Contraception
Study type: Interventional

Summary: 
      -Purpose: To develop and evaluate an intervention designed to improve consistent
      contraceptive use and dual method use in particular, among female sex workers (FSWs) in Rift
      Valley Province in Kenya.

      Design: A qualitative descriptive study will be conducted to develop the intervention. A
      quasi-experimental, non-randomized, two-group, pre-/post-intervention design will be used to
      evaluate the intervention.

      Study Population: FSWs living in Naivasha, Gilgil, and Nanyuki, Rift Valley Province.

      Study Duration: Phase I - 3 months Phase II - 12 months Objectives: Develop an intervention
      designed to increase contraceptive use among FSWs by incorporating formative data and
      behavioral theory and by involving the target audience and service providers in the
      development of the intervention.

      Examine the effectiveness of the intervention at increasing non-barrier modern contraceptive
      use and dual method use among FSWs.

      Assess the feasibility and acceptability of the intervention, on the parts of both the
      clients (FSW) and service providers.

      Estimate the unit cost to provide these services to one client. Study Site: Rift Valley
      Province, Kenya
    

Detailed description: 
      The goal of this study is to develop and evaluate a theory-based intervention that could be
      incorporated into routine health services to improve the sexual and reproductive health of
      women who engage in sex work if demonstrated to be effective. To accomplish this goal, the
      study will be conducted in two phases. During the first phase of the study, FSWs and service
      providers in the study sites will assist in the design of the intervention, in an effort to
      increase the likelihood that it will be accepted, feasible, and effective. Brief formative
      research will be conducted with FSWs and service providers, followed by working group
      meetings with self-selected FSWs, service providers, and GSKenya representatives who will
      review data and work with study investigators and/or their designees to design the
      intervention. During the second phase of this study, the intervention will be implemented and
      evaluated.

      The study is planned for two sites within Rift Valley Province, Kenya. The first "site" is
      comprised of two adjacent towns, Naivasha and Gilgil. The town of Nanyuki will serve as the
      second site.

      Based on findings from the formative phase of this study, and on observations and feedback
      from providers, a package of enhancements to the current package of services delivered to FSW
      will be implemented and evaluated.

        -  Family Planning (FP) Messaging for peer educators and informational materials material -
           Peer educators will be trained using existing materials to deliver accurate messaging on
           FP/dual method use, during individual encounters and in group sessions.

        -  Screening for unmet FP need in drop-in centers - Integration of FP needs screening in
           the service delivery points will increase the number of FSW accessing FP. This will be
           done through sensitization of service providers and provision of a brief job aid that
           can be used to screening clients for unmet need, including unmet need for dual method
           use.

        -  Providers FP counseling job aid - The AIDS, Population and Health Integrated Assistance
           (APHIA) Plus project will adapt the existing Balanced Counseling Strategy Plus: A
           Toolkit for Family Planning Service Providers Working in High HIV/Sexually Transmitted
           Infection (STI) Prevalence Settings for providers to use within the context of the DICs
           and in referral sites in the catchment area.

        -  Commodities - increasing method mix - The methods that will be available to all women
           attending services at the DIC will be expanded. In addition to the current oral
           contraceptive pills, DMPA, male and female condoms, both the intra-uterine contraceptive
           devices (IUCD) and implants will be added to the mix of methods available.

      Hours of DIC operation - Based on findings from the formative phase of the study, the hours
      of operation for DICs will be extended into the late evening hours to accommodate the
      schedules of FSW.
    

Intervention name(s): Lifestyle Counseling; Standard Health Services
Intervention type(s): Behavioral; Other
Intervention description(s): Peer educators will be trained using existing materials to deliver accurate messaging on FP/dual method use, during individual encounters and in group sessions.
Screening for unmet FP need in DICs Providing job aids to FP counselors Expanding FP methods with intra-uterine contraceptive devices (IUCD) and implants Time change in DIC hours of operation; Peer education and health services
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: APHIA AIDS, Population and Health Integrated Assistance; DIC Drop-in center; DMPA depot medroxyprogesterone acetate; DRH Division of Reproductive Health; FAIR Family AIDS Initiative Response; FHOK Family Health Options Kenya; FP Family planning; FGD Focus group discussion; FSW Female sex worker; GSKenya Gold Star Kenya; HTC HIV testing and counseling; HIV Human Immunodeficiency Virus; KNASP Kenya National AIDS Strategic Plan; MARPS Most at-risk populations; MoPHS Ministry of Public Health and Sanitation; MMS Ministry of Medical Services; NASCOP National AIDS and STI Control Program; RH Reproductive health; SRH Sexual and reproductive health; STI Sexually transmitted infection; USAID United States Agency for International Development