Effectiveness of community based HIV screening through targeted intervention project among female sex workers in East Delhi: A mixed methods study.

Abstract

Community-based screening (CBS) for (HIV) Human Immunodeficiency Virus is a critical strategy to enhance testing coverage and early diagnosis among high-risk groups (HRGs). Female sex workers (FSWs) face unique structural and interpersonal barriers to accessing HIV testing services. This study assessed the effectiveness and operational challenges of CBS implementation among FSWs through targeted intervention (TI) projects in East Delhi. A mixed-methods design was employed, combining quantitative record-based analysis with qualitative inquiry. Quantitative data were extracted from two randomly selected TI sites for April 2021-March 2022 to assess CBS indicators. Qualitative data were obtained from eight in-depth interviews with TI staff and eight focus group discussions with FSWs. Data were analysed descriptively and thematically to identify patterns and triangulate findings. A total of 4582 beneficiaries were screened through CBS, of which 19.3% were first-time testers. Partner testing uptake was minimal (17 partners screened). Qualitative data revealed CBS was preferred over Integrated Counselling and Testing Centres due to convenience, confidentiality, and minimal income loss. Barriers included stockouts, logistical delays, inadequate remuneration for TI staff, and stigma at facility-based testing centres. CBS significantly improved HIV testing coverage and accessibility among FSWs in East Delhi. However, gaps in linkage to ART and supply chain disruptions limit its impact. Strengthening logistics, enhancing staff incentives, and integrating mobile confirmatory testing can further optimize CBS implementation.