title: Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa.
abstract: BACKGROUND
  Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.
  
  
  METHODS
  On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools.
  
  
  RESULTS
  We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.
  
  
  CONCLUSIONS
  Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs' health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
authors.forename: Ashar
authors.initials: A
authors.lastname: Dhana
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
authors.forename: Lizzie
authors.initials: L
authors.lastname: Moore
authors.forename: Yves
authors.initials: Y
authors.lastname: Lafort
authors.forename: Anuradha
authors.initials: A
authors.lastname: Roy
authors.forename: Fiona
authors.initials: F
authors.lastname: Scorgie
authors.affiliation: Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. matthew.chersich@wits.ac.za.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chersich
mesh_terms: D000349:Africa; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003376:Counseling; D005260:Female; D005380:Financing, Government; D014943:Global Health; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D034121:Reproductive Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D021841:Safe Sex; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000517:prevention & control
chemical_list: D044966:Anti-Retroviral Agents