Spatial Mapping of Sexual Network Locations and Utilization of HIV/STI Preventive Services among Long-distance Truck Drivers Using the Northern Corridor Highway, Kenya

Abstract

Globally, long-distance truck drivers (LDTDs) are highly vulnerable to risky sexual networks while on transit. Moreover, the LDTDs have limited access to HIV and sexually transmitted infection (HIV&STI) preventive services. In Kenya, along the Northern Corridor highway, little is known about the distribution of the sexual network locations used by the LDTDs, making it hard to provide spatially targeted HIV/STI preventive interventions. The general objective was to determine the spatial distribution of sexual network locations and utilization levels of HIV/STI preventive services among LDTDs using the Northern Corridor highway in Kenya. A cross-sectional study was conducted among 296 LDTDs who made a stopover at Mlolongo weighbridge in Machakos. The LDTDs listed their history of sexual interactions and highway stopovers used over the week preceding data collection, together with their patterns of utilization of HIV/STI preventive services while on transit. Shapefiles were created and overlaid over the map of Kenya using the R statistical software to create maps of sexual network locations. Descriptive statistics yielded; socio-demographic & socioeconomic characteristics, frequency of sexual interactions, and utilization levels of HIV/STI preventive services among study participants. A composite outcome variable on utilization of HIV/STI preventive services was derived from; condom use, history of HIV testing, frequency of HIV testing, antiretroviral therapy (ART) use, and STI treatment. Ordered logistic regression and binomial logistic regression were used to determine the factors associated with the frequency of sexual interactions and the utilization of HIV/STI preventive services. The mean age of study participants was 38.4 years, ranging from 24-57 years. Generally, clusters of sexual network hotspots among the LDTDs were restricted to the outskirts of major cities along the Northern Corridor highway (Nairobi, Mombasa and Nakuru) and the Kenya-Uganda international border. The majority of the respondents, 231 (78.0%) had good utilization of HIV/STI preventive services, while the rest, 65 (22%), had limited utilization. The number of weeks spent on a transit journey, that is, one week (OR=1.89, 95% CI: 1.02, 3.53; P=0.045), two weeks and above (OR=4.16, 95% CI: 2.25, 7.81; P<0.001), as well as age (OR=0.91, 95% CI: 0.88, 0.95; P<0.001), use of alcohol (OR=10.9, 95% CI: 5.33, 22.9; P<0.001) and Khat (OR=7.05, 95% CI: 3.46, 14.75; P<0.001), were independently associated with a high frequency of sexual interactions among LDTDs involved in the study. Only the history of STIs (OR=8.4, 95% CI: 4.5, 16.7; P<0.001) among the LDTDs was independently associated with the utilization of HIV/STI preventive services. In conclusion, the distribution of sexual network hotspots is generally restricted to the Kenya/Uganda border, and proximally to major urban areas along the Northern Corridor highway. Despite 78% in good utilization of HIV/STI preventive services, uptake of the subsequent HIV testing services among the LDTDs is still low at 4.9%. More HIV/STI preventive interventions should be focused on the young LDTDs, those who spent above one week on transit, and those who use alcohol and khat due to their high frequency of sexual interactions. Further research is recommended to determine the factors influencing the uptake of subsequent HIV testing services among the LDTDs, to scale up the low uptake of 4.9% identified in this study.