Table 4 Challenges faced by service providers and female sex workers within different HIV testing service delivery models along Malaba-Kampala highway, Uganda

Service providers/health workers

Service providers were faced with stock out of testing kits to meet the demand of HCT services. This was reported to happen when there was good mobilization and many people turn up for testing especially during outreaches. This challenge was especially observed where mobilization was done by an NGO and testing kits were provided by government health facilities.

At the facility level, some periods were reported when they were no testing kits; the few available were reserved for pregnant women. So sometimes female sex workers and other people were told to come back later, those who could afford to pay would go to private clinic

A number of problems were found to be associated with outreaches. Some of the business owners did not what health workers to carry out HIV testing at their premises as this would disrupt their business

Some female sex workers do not trust results given during outreaches especially if blood is picked from a finger. People still think that a lot of blood should be used for HIV testing and the testing should be done in laboratory with a microscope

Most outreaches are irregular and mainly depend on the availability of funds and testing kits. This always make linkage into care very impossible due to the fact that female sex workers are mobile and move depending on availability of clients and sometime they move with their clients.

Female sex workers

Female sex workers also faced challenges during the provision of HIV service to them. Most of them report long waiting hours especially in static clinics where services were provided to them together with the general population. This made most of them to miss HCT and other related services.

Female sex workers also reported that most of the places do not have specific clinic for female sex workers making services provided to them being not user friendly. In most of the “hot spot” areas visited there was only one specific clinic serving female sex workers and the few available clinic had no funder which had lowed service provision to this category of people

Stigma and discrimination is still high among female sex workers especially from the health workers who have not been trained in provision of friendly services for KPs, this was one of the reason that was reported by female sex workers not taking HCT services

Female sex workers also complained about low or lack facilitation for peer leaders. These do voluntary worker and most of the time they are not compensated for their work yet they lose time and customers when doing this.

The quality of services was reported to be poor due to the fact that there was no holistic service provided to female sex workers during outreaches. They suggested for inclusion of others services during outreaches such as tests for Hepatitis B, syphilis etc. This would improve on the quality of services provided to them and would encourage other colleagues to come because of the variety of the service that they expect to receive as shown by the quote.