The effects of sexually transmitted infection (STI) testing on STI prevalence and safe sex behaviours of brothel sex workers in Bangladesh

1. Brief name: Urine testing for sexually transmitted infections (STIs) 2. Why: No studies have looked at the associated sexual behaviours of female sex workers (FSWs) in Bangladesh after they are informed of their STI results. Past studies have shown that FSWs, especially those in developing countries, are less likely to seek treatment for STIs due to factors such as lack of money, lack of knowledge, and stigmatisation from health care professionals. They may even continue to engage in unprotected sex despite knowing their STI-positive status. This intervention examines whether providing STI testing to brothel sex workers (BSWs) in Bangladesh, informing them their test results, and providing information about where to seek treatment among those tested positive may influence their subsequent sexual behaviours. 3. What (materials): Each BSW in the intervention group received a urine bottle to collect their urine specimens. 4. What (procedures): Each BSW in the intervention group received a urine bottle the night before the urine collection from the designated urine collectors in our study. BSWs in the intervention group were instructed by the urine collectors to use the bottles to store their first morning urine the following day. The urine collectors returned to the brothels the following morning to collect the urine specimens from the BSWs. The urine specimens were then deposited into coolers and transported to the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to test for chlamydia, gonorrhoea, herpes type I, herpes type II and syphilis. After the STI testing results were released by ICDDR,B, a certified doctor visited the brothels to inform the BSWs of their test results. The doctor also advised STI-positive BSWs on where to seek for STI treatment by providing them the names and addresses of the closest clinics. 5. Who provided: Two urine collectors trained by ICDDR,B with regard to the collection and storage of urine specimens. A certified doctor informed the BSWs of their urine test results and where to seek treatment if they were tested STI-positive. The doctor is currently a practising doctor at a government hospital in Bangladesh. 6. How: The urine collectors handed out the urine bottles and provided instructions to each BSW individually in person. The doctor informed BSWs of their urine test results individually in person. 7. Where: The urine test trial was conducted in two brothels, Mymensingh and Tangail, in Bangladesh. The urine test bottles were handed out to BSWs individually in each of their rooms at the brothels. The doctor informed BSWs of their urine test results individually in each of their rooms at the brothels. 8. When and how much: The urine test bottles were handed out to BSWs in the intervention group the night before their urine specimens were collected by our urine collectors the following morning. 9. Tailoring: After the urine specimens were analysed, a certified doctor in our study visited the BSWs individually to inform them of their urine test results. 10. Modifications: Nil. 11. How well (planned): The urine collectors in our study were trained by ICDDR,B on the collection and storage of urine specimens. The doctor in our study was instructed to deliver the urine test results to BSWs and to advise STI-positive BSWs on where to seek treatment by providing BSWs with the names and addresses of the closest clinics. 12. How well (actual): Urine specimens of all BSWs (235) in the intervention group were successfully analysed for STIs.