Monday, April 4, 2016

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

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%.

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.

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 CharacteristicsWithin 7 daysWithin 14 days
Odds ratio exp β (95% CI)P valueOdds ratio exp β (95% CI)P value
 20–24 years (rc)
 15–19 years0.37 (0.20–0.67)0.0010.33 (0.17–0.64)0.001
Highest education level
 None/primary education (rc)
 Secondary education0.42 (0.17–1.04)0.0590.44 (0.16–1.19)0.105
 Postsecondary education0.34 (0.12–0.99)0.0470.20 (0.06–0.65)0.008
Population group
 Young MSM (rc)
 Young transgender people0.18 (0.03–0.97)0.0470.44 (0.09–2.04)0.291
 Nonstudents (rc)
 Students1.16 (0.50–2.71)0.7321.85 (0.73–4.66)0.196
Location of social network
 Areas within and around tertiary institutions (rc)
 Open parks and recreation centres0.82 (0.39–1.73)0.6060.89 (0.39–2.01)0.777
 Municipal areas2.64 (0.40–17.38)0.3130.53 (0.90–3.09)0.477
 Resource centres0.67 (0.22–2.07)0.4830.42 (0.13–1.37)0.152
 Constant5.24 (1.83–15.00)0.00212.05 (3.57–40.73)0.00
 Total number of cases210210
 Model χ2 (df = 8)21.4721.85
 Model significance (P value)0.0060.0052
 log likelihood−134.588−122.041
CI, confidence interval; rc, reference category.

Full article at:

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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