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Table 2 Themes, Codes, and Exemplar Quotes of FSW Differentiated Care

From: My condition is my secret”: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

Themes

Codes

Exemplar quotes

DSD models currently accessed by FSW

Facility based DSD model:

•Fast track drug refill

•Facility based individual management

Facility based DSD models

“I come to the facility, and I give in my card, until they call me to see a doctor or nurse. They examine me and If I need some tests, they send me to the laboratory for tests (FBIM)” (26 years FSW, 2 years on ART)

Community based DSD models

•Community Client Led ART delivery model

•Community Drug Distribution Point, specifically Drop-in Centres

Community based DSD models

“There is another delivery model which is currently on, where the peers pick drugs for us, or we alternate among us CLLAD members. You just need to give a group member your ART number and they pick drugs for you from the facility” (25 years FSW, 1 year on ART)

DSDs preferred by FSWs and the reasons for preference

A.Facility based DSD models

FBIM

•Access to free medication for all illnesses

•Privacy and confidentiality

FTDR

•Reduced waiting time

B.Community based model

Community pharmacy and DICs

•Easy access

•Flex and long working hours

•Friendly health workers

CCLAD

•Reduced transport costs

A.Facility based DSD models

“I don’t spend money on any kind of treatment because I get all the health services I may need when I come at the facility. Once I get fever or cough, I still get treatment. I am able to get all the health services I may want as long as I come by myself at the facility” (37 years FSW, 5 years on ART)

“I would not want that to happen to me (community members knowing her status). I would rather collect the drugs for myself at the facility, my condition is my secret” (35 years FSW, 3 years on ART)

B. Community based model

“I really feel at peace in this place (DIC), the way the doctors treat us, they handle us with care. They understand the health services that suit us, so we feel free to open up when we have issues” (28 years FSW, 3 years on ART

“Another thing is one can easily access the ARTs whenever she feels like since they are in the community. Even if a person forgets to pick her drugs, she can easily go there and pick more ARTs” (32 years FSW, 10 years on ART)

Barriers to FSWs’ uptake of preferred DSD models

A.Facility based models

•Non-flexible and short working hours

•Poor health workers’ attitude

•Failure to adapt to the social contexts of FSWs during service delivery

A.Facility based models

“The challenge I face is that those people (facility staff) stop receiving ART cards at midday. So, when you come past midday, they may not serve you. Because we work at night, we have fatigue in the morning and you may be late” (32 years FSW, 3 years on ART)

“They isolate us to the extreme. At my previous facility, there is a doctor who made a statement to me which made me shed tears. Remember I am a strong person now imagine how it would feel for someone who needs a lot of encouragement” (28 years FSW, 3 years on ART)

“I faced a challenge one time when the health workers were asking me to bring my partner for testing. I had told them that I am sexually active but had not disclosed that I do sex work, they were stressing me every time I come, may be because I would be having STIs, almost every visit. I felt like shifting from that facility”. (35 years FSW, 3 years on ART)

B.Community based models

•Lack of trust and conflicts in groups

•Community stigma

•Limited-service packages

B.Community based models

They (CCLAD members) don’t even gossip about our HIV status only, they even talk about your other private things. For example, me, I am married but also do sex work, imagine if someone told my husband and children!!!” (30 years FSW, 4 years on ART)

“Something that we do today will affect us in future in that even if you reach a time and quit the sex work job, people will not believe you. So, they may even discriminate against your children and even insult them that they are children of a sex worker. We suffer much criticism from the community members, and this becomes challenging to seek care from the service centre in my community” (28 years FSW, 3 years on ART)

“If I attend to these other places where services are just brought to us, I may have fever, or an infection or cough and they fail to give me the treatment. They just prescribe for me the medicine and they tell me to go and buy it, because they don’t carry all medicines, yet I come here knowing that medicine is available” (27 years FSW, 4 years on ART)