JMIR Publications

ABSTRACT

Background:

Assessing HIV outcomes in key population prevention programmes is a crucial component of the programme cycle as it facilitates improved planning and monitoring of expected results. UNAIDS recommends using simple and rapid methods to routinely measure granular and differentiated programme outcomes for key populations. Partners for Health and Development in Africa, in partnership with the Nairobi County Government and the University of Manitoba, conducted an outcome assessment study using a Programme Science approach with female sex workers and men who have sex with men in Nairobi, Kenya.

Objective:

The objectives of the study were to a) estimate the incidence and prevalence of HIV; b) assess biomedical, behavioural and structural outcomes; and c) understand the barriers contributing to gaps in access and utilization of available prevention and treatment services among female sex workers and men who have sex with men in Nairobi County.

Methods:

The study employed a novel approach that uses complementary methods for data collection, referred to as the enhanced Polling Booth Survey (ePBS) method. The approach enhances the traditional Polling Booth Survey (PBS) method by incorporating additional qualitative, quantitative, and biological data collection and an improved sampling methodology. The quantitative methods include: a) PBS, a group interview method in which individuals provide responses through a ballot box in an unlinked and anonymous way; and b) Behavioural and Biological Survey (BBS), which includes a face-to-face individual interview and collection of linked biological samples. The qualitative methods include focus group discussions. The ePBS study employed a two-stage, population- and location-based, random sampling approach, involving the selection of random locations in the first stage and selection of random participants from selected locations at a predetermined time on a randomly selected day in the second stage. PBS data will be analysed at the group level and the BBS data will be analysed at individual level. Qualitative data will be analysed thematically.

Results:

Data was collected during April – May 2023. The study enrolled a total of 759 female sex workers (99% response rate) and 398 men who have sex with men (95% response rate). Data cleaning and analysis is ongoing and is expected to be completed by December 2023.

Conclusions:

The study aims to generate valuable HIV outcome data that can inform programme improvement and policy development in Nairobi County’s key population HIV prevention programme. Additionally, this study serves as a pilot for a novel ePBS method that combines PBS, BBS and FGD to enhance its programmatic utility. The ePBS method holds the potential to fill an acknowledged gap for a rapid, low cost and simple method to routinely measure HIV outcomes within programmes and inform incremental programme improvements through embedded learning processes.