title: Reaching the unreachable: providing STI control services to female sex workers via mobile team outreach.
abstract: BACKGROUND
  As part of a community-randomized trial of a multicomponent intervention to prevent sexually transmitted infections, we created Mobile Teams (MTs) in ten intervention cities across Peru to improve outreach to female sex workers (FSW) for strengthened STI prevention services.
  
  
  METHODS
  Throughout 20 two-month cycles, MTs provided counseling; condoms; screening and specific treatment for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and vaginal Trichomonas vaginalis (TV) infections; and periodic presumptive metronidazole treatment for vaginal infections.
  
  
  RESULTS
  MTs had 48,207 separate encounters with 24,814 FSW; numbers of sex work venues and of FSW reached increased steadily over several cycles. Approximately 50% of FSW reached per cycle were new. Reported condom use with last client increased from 73% to 93%. Presumptive metronidazole treatment was accepted 83% of times offered. Over 38 months, CT prevalence declined from 15.4% to 8.2%, and TV prevalence from 7.3% to 2.6%. Among participants in ≥ 9 cycles, CT prevalence decreased from 12.9% to 6.0% (p <0.001); TV from 4.6% to 1.5% (p <0.001); and NG from 0.8% to 0.4% (p = 0.07).
  
  
  CONCLUSIONS
  Mobile outreach to FSW reached many FSW not utilizing government clinics. Self-reported condom use substantially increased; CT and TV prevalences declined significantly. The community-randomized trial, reported separately, demonstrated significantly greater reductions in composite prevalence of CT, NG, TV, or high-titer syphilis serology in FSW in these ten intervention cities than in ten matched control cities.
authors.affiliation: Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Campos
authors.forename: Anne L
authors.initials: AL
authors.lastname: Buffardi
authors.forename: César P
authors.initials: CP
authors.lastname: Cárcamo
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: García
authors.forename: Clara
authors.initials: C
authors.lastname: Buendia
authors.forename: Marina
authors.initials: M
authors.lastname: Chiappe
authors.forename: Geoff P
authors.initials: GP
authors.lastname: Garnett
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Xet-Mull
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D003159:Community-Institutional Relations; D005260:Female; D006801:Humans; D010348:Patient Care Team; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000145:classification / Q000453:epidemiology / Q000517:prevention & control*