Key results
HIV and schistosomiasis
SCHISTOSOMIASIS
The main findings from this study included low utilization of free HIV services and schistosomiasis treatment (Praziquantel) among a high risk population of fishermen on the shores of Lake Malawi, (indicating that service integration is likely to increase uptake of both services), and extremely high willingness to attend beach clinics. The literature identifies mobility among fishermen, inconvenient offer of health services where there is mistiming, long distances to health facilities and stigma as key factors that contribute to low utilization[The recent data from the Malawi population-based HIV impact assessment (MPHIA) indicate that 12% of people living with HIV in Malawi are not aware of their HIV status [Malawi implements twice a year mass drug administration of praziquantel among the fishing communities[Contrary to the strongly held opinion that fishermen are unwilling to utilize health services, we found extremely high willingness to attend a mobile beach clinic when offered hypothetically among the surveyed fishermen. The key difference was that we made it clear that such a beach clinic would firstly be made available right on the lakeshore to provide convenience and secondly that fishermen would be able to access it during a wide range of hours. Such a flexible approach in service delivery has been shown in various studies and programmes to increase the uptake of services dramatically, especially for men[The main strength of this study is that we showed promising results on potential significant uptake of integrated HIV and schistosomiasis services among the fishing population in Mangochi, Malawi as this will inform demand creation efforts.The main limitation of this study was that it gives a snapshot of the baseline prevalence of the two hazards, but does not measure the impact of the services being rendered in the beach clinics. Self-reporting of HIV testing and uptake of the schistosomiasis drug praziquantel might have contributed to information bias. Given that all outcomes were self-reported there is likelihood of information bias. HIV and schistosomiasis services are free of charge and fishermen know that they are a priority population. Thus, social desirability bias would have been likely whereby fishermen may have reported that they tested for HIV or took Praziquantel when in fact they had not done so. For both HIV and schistosomiasis, distance to the nearest health facility may be an important factor which was not included in the data reported here.The study findings are generalizable to Malawi fishermen over 18 years of age and the large sample size was critical in reducing random errors. However, following this baseline study, there will be a cluster-randomized trial which will enhance both the internal and external validity of the study outcomes.