Outline Abstract information Title page/presenter information Background Rationale Methodology Results Conclusion

Abstract Information Session Title: Key populations: innovative implementation Session Date: Tuesday, 1 December 2015 Session Time: 16:45 - 18:15 Session Room: Jacaranda 3 Abstract no: A-751-0003-00860

IKANI, Samuel Ojonugwa [M.Sc, B.Sc.] Participant Number: 925 Assessing HTC and STI consultation service delivery for key populations in Nigeria through a mystery client survey (TUAC0604) IKANI, Samuel Ojonugwa [M.Sc, B.Sc.] Participant Number: 925

Background Access to sexual and reproductive healthcare services for key populations is critical for lessening the spread of HIV. Findings from researches also show that provision of HCT, early diagnosis and treatment of STIs, can contribute to reducing the spread of HIV. In Nigeria as well as in most sub-Saharan African countries, key populations are highly stigmatized within the general population and subliminally in the provision of healthcare services at health facilities. It is imperative to know and understand possible facilitators and barriers to facility based healthcare for key populations which can strengthen the design and implementation as well as policy formulation with regards to healthcare delivery for key population

Rationale Health seeking behaviours by key populations is likely to improve if they are satisfied with the quality of services received at health facilities. This will imply their willingness to revisit such facility and most importantly refer other members of the key population for similar services. Efforts has been made by the USAID funded Strengthening HIV Prevention Services for MARPs project in Nigeria to build capacities of healthcare providers in selected health facilities, in the project states to offer non-stigmatized health care services to key populations. However, very limited evidence exist to indicate the quality of services offered by these trained providers to the members of key population.

Methodology Data for this study was collected by Mystery clients who are key population 314 of over 7,500 members of the key populations on the prevention programme were recruited and trained for the study and their composition were: Female Sex Workers = 109(35%), Persons who Inject drugs = 101(32%) & Men who have sex with men = 104(33%) These mystery clients visited selected health facilities on a scheduled date with the intention of either obtaining HIV counselling and testing or STI consultation services. After receiving any of these services, they completed a structured questionnaire, documenting their experiences with the healthcare providers. The survey was conducted 12 of 37 states in Nigeria where the USAID-SHiPS project was implemented in 2014. 33 public & private health facilities were purposefully selected across the 12 states. These facilities were selected, as they are referral centers for the project. Ethical approval for this study was obtained from Nigeria Institute of Medical Research (NIMR) with IRB number 12201.

Results (1/1) Only 301 completed questionnaires were returned. These questionnaires were then coded and analysed using SPSS V 20. About 85% of the respondents reported that the health facilities visited were easily accessible and found operations time from Mondays to Fridays convenient. Posters, pamphlets and other health communication materials were visible to about 50% of respondents but only about a third believed the materials addressed their needs and concerns indicating many of the facilities have communications targeted at the general population. Although a good majority (71%) reported that they were counseled in separate rooms, confidentiality of interactions could not be guaranteed or was compromised as 50% of the respondents believed that their conversation could be overheard by others around

Results (1/2) A little over half were assured of confidentiality of the counselling session; and less than a fifth were asked to use a number, pseudonym or another name to ensure confidentiality. Only about 50% of the mystery clients who accessed STI consultation adjudged the providers to be friendly, welcoming, and non-judgmental after they self-identified as an FSW, MSM or IDU. About 56% reported that the providers explored the use of condoms in multiple and concurrent sexual relationships while 39% reported that the healthcare counseled on partner reduction A little above 45% reported that healthcare provider discussed to need to adhere to drugs while treating the STIs 62.6% of the mystery clients were referred by providers to other facility

Conclusion Critical issues from this study are: Poor information exchange between providers and their clients. Providers did not firmly follow the National HTC and STI protocols for eliciting required information that should inform their interactions with clients, particularly on assuring and ensuring confidentiality. There is a need to provide communication materials that are key population specific at health facilities It vital to strengthen health workers training programme to offer more satisfactory health services to members of the key populations in Nigeria.

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