JMIR Publications

ABSTRACT

Background:

In many countries, adolescent girls and young women (AGYW) with higher risk sexual lifestyles, such as young women who sell sex (YWSS), are hard to reach with HIV prevention and care services. The DREAMS Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of AGYW, including YWSS, in 10 sub-Saharan African countries. We describe two methods, respondent-driven sampling (RDS) and peer-outreach, used in Zimbabwe to refer YWSS for DREAMS services offered through a national sex worker programme and compare the characteristics and engagement of YWSS referred to the DREAMS services by each method. We assessed which strategy was more feasible, hypothesising that RDS is faster and recruits higher risk and more hidden YWSS than peer-outreach alone.

Objective:

To compare the performance of respondent-driven sampling and peer-outreach in recruiting and referring high risk populations for HIV services.

Methods:

We used RDS, a research sampling method, and peer-outreach, a programmatic approach to identify, reach and refer YWSS for DREAMS between April-July 2017 and January 2017-July 2018, respectively, in two cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, then purposively selected 10 ‘seed’ participants in each city to initiate RDS. For peer-outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth tailored community mobilisation. We described characteristics and service engagement of YWSS who accessed DREAMS services by referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was done with and without restricting to the period when RDS took place.

Results:

Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer-outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer-outreach (42% (501/1204) vs 17% (930/5386); P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar levels of education, and a similar proportion tested HIV negative and did not use condom at last sex. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 (33% (167/501) vs 26% (243/930); P=.004), and more likely to be aware of their HIV status compared to those accessing DREAMS services through peer-outreach (79% (395/501) vs 43% (396/930); P<.001).

Conclusions:

Both RDS and peer-outreach are equally feasible in reaching and referring high risk but different groups of women to HIV services and using complimentary approaches will likely be beneficial.