The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: Experience from ‘HIM’ initiative

Introduction

The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15–24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%.

Methods

Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services.

Results and discussion

A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections.

Conclusion

The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.

Below:  Distribution of turnaround time for voucher redemption to access sexual and reproductive health and HIV services among respondents

Predictors of voucher turnaround time among young MSM and transgenders in Dhaka, Bangladesh

Social Characteristics	Within 7 days		Within 14 days
	Odds ratio exp β (95% CI)	P value	Odds ratio exp β (95% CI)	P value
Age
20–24 years (rc)
15–19 years	0.37 (0.20–0.67)	0.001	0.33 (0.17–0.64)	0.001
Highest education level
None/primary education (rc)
Secondary education	0.42 (0.17–1.04)	0.059	0.44 (0.16–1.19)	0.105
Postsecondary education	0.34 (0.12–0.99)	0.047	0.20 (0.06–0.65)	0.008
Population group
Young MSM (rc)
Young transgender people	0.18 (0.03–0.97)	0.047	0.44 (0.09–2.04)	0.291
Occupation
Nonstudents (rc)
Students	1.16 (0.50–2.71)	0.732	1.85 (0.73–4.66)	0.196
Location of social network
Areas within and around tertiary institutions (rc)
Open parks and recreation centres	0.82 (0.39–1.73)	0.606	0.89 (0.39–2.01)	0.777
Municipal areas	2.64 (0.40–17.38)	0.313	0.53 (0.90–3.09)	0.477
Resource centres	0.67 (0.22–2.07)	0.483	0.42 (0.13–1.37)	0.152
Constant	5.24 (1.83–15.00)	0.002	12.05 (3.57–40.73)	0.00
Total number of cases	210		210
Model χ2 (df = 8)	21.47		21.85
Model significance (P value)	0.006		0.0052
log likelihood	−134.588		−122.041

CI, confidence interval; rc, reference category.

Full article at:  http://goo.gl/pWRV2T

By:  Tajudeen O. Oyewale,a,† Shale Ahmed,b Farid Ahmed,f Mona Tazreen,f,∗ Ziya Uddin,c,† Anisur Rahman,d and Kola A. Oyedirane,‡

^aHIV Section, United Nations Children's Fund, New York City, New York, USA

^bBandhu Social Welfare Society

^cHIV Programme, United Nations Children's Fund

^dNational AIDS/STD Programme, Ministry of Health and Family Welfare, Dhaka, Bangladesh

^eJohn Snow Inc., Arlington, Virginia, USA

^fHIV Programme, UNICEF Bangladesh, Dhaka, Bangladesh

Correspondence to Tajudeen O. Oyewale, MBBS, MPH, PhD, UNICEF House, 3 UN Plaza, New York 10017, NY, USA. Tel: +1 212 326 7567; 

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