December 2006

Studies in Brief
Testing on the Road: Brazilian study finds support for VCT among truckers

Reaching mobile populations, like truck drivers, with health services, including HIV testing, requires innovative strategies. Photo credit: Johannes van Dam/Population Council

Highly mobile populations like truck drivers who spend much of their time on the road are often challenging to reach with traditional voluntary counseling and testing (VCT) services. To examine the feasibility of offering VCT, HIV treatment, and other health services to truckers, Horizons conducted an operations research study in Foz do Iguaçu, a town on the triple border between Brazil, Argentina, and Paraguay.

The study began with focus group discussions and in-depth interviews with truckers, sex workers, and customs officials to learn more about HIV risk among truckers. The research found that truckers were often required to remain in the customs area for two to three days until documentation was completed, and that they were reluctant to leave their vehicles. A booming commercial sex area existed directly in front of the station; however, condoms were not easily available. The truckers also reported societal prejudice against them and perceptions of them being vectors of disease, suggesting that sensitivity is necessary when approaching truckers about HIV services.

With support from the USAID Mission in Brazil and the Municipal Secretariat of Health of Foz do Iguaçu, a multi-faceted intervention was designed based on these findings. Truckers who were waiting to cross the border were approached by two outreach educators who gave them educational materials and invited them to a mobile trailer inside the customs area to receive health services, including testing and counseling for HIV and syphilis. Those who agreed to access VCT received pre-test counseling, provided a blood sample, and were given a follow-up visit in 15 days to receive test results and post-test counseling. In addition, all truckers were offered an STI syndromic management consultation, STI/HIV education, and preventive health services, such as blood pressure and diabetes screening.

The intervention was evaluated by comparing cross-sectional data collected from truckers passing through the customs station in Foz do Iguaçu with truckers crossing a comparison border town (Uruguaiana) before and after the intervention. Interviews were held with a randomly selected sample of 1,775 male truckers before the intervention and 2,408 male truckers 18 months later. In addition, a qualitative evaluation consisting of focus group discussions and in-depth interviews with truckers and sex workers was conducted at the end of the intervention in Foz do Iguaçu. Truckers who came to the trailer for HIV and syphilis testing and counseling also completed a questionnaire on the quality of services received.

The intervention was successful in reaching a substantial proportion of truckers: about half of the truckers who gave follow-up interviews in the intervention site had participated in the intervention. A third reported visiting the trailer and accessing VCT, and an additional 22 percent participated in educational activities or received educational materials or condoms. Only 13 percent of respondents in the intervention site had not heard of the project. Service statistics collected during the 18 months of the intervention also indicated that the intervention reached thousands of truckers with educational activities, materials, and condoms.

Raising interest in HIV testing was another particularly successful result of the intervention. At baseline, less than half of respondents in both sites had ever had an HIV test. At follow-up, ever having an HIV test increased by 49 percent in the intervention site but only by 15 percent in the comparison site. In addition, 105 men and women who worked at the custom station in Foz do Iguaçu went to the trailer for VCT.

During the intervention period, 1,944 truckers received pre-test counseling for HIV and syphilis and 1,795 gave a blood sample. Of these, 1,492 truckers (83 percent) returned 15 days later for test results and post-test counseling. Only five truckers tested positive for HIV (0.3 percent), and three of them were referred to the municipal STI/HIV program for follow-up. One did not consent to come back to be referred, and the fifth could not be reached. Those individuals who tested positive for syphilis (4.7 percent) were treated and referred to an STI clinic.

Truckers were highly receptive to the intervention, based on both qualitative interviews and survey responses.

This service was the best thing in this region. Now, you have a problem and you have all you want here, not needing to go to other places and you use the time when you are waiting the liberation of your truck.
—Brazilian trucker

I really loved the way I was treated . . . the nurses and all the health workers are very helpful and kind . . . they know how to treat people.
—Paraguayan trucker

The great majority of VCT participants also responded to a questionnaire to evaluate the intervention (94 percent of 1,944). Almost all survey respondents (99 percent) rated the services as “great” or “good.” The main reasons offered for high levels of satisfaction were that the services were easily accessible (29 percent), the educational messages were very useful (23 percent), and the services were not only for HIV/STIs but also for other common diseases (19 percent).

Results from this intervention support the strategic placing of services to reach truckers and other mobile populations. They suggest that a range of basic health services in addition to VCT and HIV/STI prevention should be provided to encourage participation. Further, it is essential that high quality, confidential care be offered by attentive staff free of stigmatizing attitudes, as this was key for attracting truckers. To sustain activities and to enhance the project’s credibility, partnerships with both private and public local institutions are critical. The operation of the health services has been transferred to a local university, which will continue providing them free of charge, and very likely will broaden the scope of services offered. As this study was conducted in a low prevalence setting, further research is recommended to test the effectiveness of this approach for providing not only VCT but also antiretroviral treatment to truckers who test positive.

For more information about this study, contact Juan Diaz (jdiaz@popcouncil.org.br).

—Hena Khan

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© 2006 The Population Council, Inc.

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See Also

• FRONTIERS

• Population Council – Infants and Children

• Population Council – Journals and Newsletters

• Population Council – Prevention

• Population Council – Youth

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This page updated 11 January 2007

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