Healthcare use and sexually transmitted infections treatment-seeking: a mixed methods cross-sectional survey among hard-to-reach fishing communities of Lake Victoria, Uganda.

Introduction: Uganda´s fishing communities experience a high burden of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), with limited access to healthcare. Knowledge on healthcare use and treatment seeking will help identify unmet needs and facilitate appropriate allocation of resources.

Methods: between 2014-2015, a mixed methods cross-sectional survey was conducted in four fishing communities on Lake Victoria, Uganda, as part of preparedness for HIV trials. The goal was to understand health problems (having any illness, medical condition, or injury in the past 12 months), perceptions of healthcare, health services use, and factors associated with seeking STI care. Data were collected from participants aged 13-49 years; quantitatively using a structured questionnaire and qualitatively via focus group discussions (FGDs) and key informant interviews (KIIs). Information covered recent health problems, health services use, and healthcare perceptions. Multivariable logistic regression modeling was used to determine factors associated with seeking care for STIs.

Results: participants´ median (interquartile range) age was 29 (23-35) years, more than half (51.9%, 763/1,469), were females, and the majority (60.4%, 888/1,469) had up to seven years of formal education. Most participants reported having had health problems (76%, 1,117/1,469). The most frequently reported health issues were STI symptoms (52.6%, 587/1,117). Lack of health services was mentioned as one of the reasons for not seeking care during the FDGs and KIIs. Adolescents, 13-19 were less likely to seek care for STIs symptoms than adults of 20 or more years (aOR= 0.5 (95% CI 0.3-0.9)). Females were more likely to seek STI treatment (aOR= 1.4 (95% CI 1.0-2.1)), as were participants who worked mainly in bars, restaurants or lodges (aOR= 2.0 (95% CI 1.1-3.6)).

Conclusion: in these communities, adolescents have low treatment seeking for STIs symptoms.