Clinic appointment attendance for sexually transmitted infection screening among Filipina sex workers: A multilevel analysis

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Abstract
This study evaluates putative individual- and contextual-level social risk factors that may influence the likelihood that Filipina female sex workers (FSWs) attend and utilize health services for STI screening. Face-to-face interviews were conducted with 1004 FSWs and their 86 employers. Research staff also collected clinic appointment attendance data. Hierarchical linear modelling was used to estimate the simultaneous effects of individual- and workplace-level factors. Results showed that both individual- and contextual-level characteristics were associated with STI screening appointment attendance. Individual characteristics found to have significant effects on clinic attendance included occupation, income, length of work and commercial sex involvement. City of establishment was a workplace characteristic significantly associated with appointment attendance. In addition to cross-level interactions, the impact of individual-level occupation depended upon characteristics of the workplace. These findings suggest that individual health service utilization is contingent upon contextual-level risk factors in the workplace. Intervention implications aimed at increasing clinic attendance are discussed.