BACKGROUND:
HIV
epidemiology and intervention uptake among female sex workers (FSW) in
sub-Saharan Africa remain poorly understood. Data from outreach programs are a
neglected resource.
METHODS:
Analysis
of data from FSW consultations with Zimbabwe's National Sex Work program,
2009-2014. At each visit, data were collected on sociodemographic
characteristics, HIV testing history, HIV tests conducted by the program and
antiretroviral (ARV) history. Characteristics at first visit and longitudinal
data on program engagement, repeat HIV testing, and HIV seroconversion were
analyzed using a cohort approach.
RESULTS:
Data were
available for 13,360 women, 31,389 visits, 14,579 reported HIV tests, 2750
tests undertaken by the program, and 2387 reported ARV treatment initiations.
At first visit,
- 72% of FSW had tested for HIV;
- 50% of these reported being HIV
positive.
Among HIV-positive women,
- 41% reported being on ARV.
- 56% of FSW
attended the program only once.
FSW who had not previously had an HIV-positive
test had been tested within the last 6 months 27% of the time during follow-up.
After testing HIV positive, women started on ARV at a rate of 23/100 person
years of follow-up. Among those with 2 or more HIV tests, the HIV
seroconversion rate was 9.8/100 person years of follow-up (95% confidence
interval: 7.1 to 15.9).
CONCLUSIONS:
Individual-level
outreach program data can be used to estimate HIV incidence and intervention
uptake among FSW in Zimbabwe. Current data suggest very high HIV prevalence and
incidence among this group and help identify areas for program improvement.
Further methodological validation is required.
By: Hargreaves JR1, Mtetwa S, Davey C, Dirawo J, Chidiya S, Benedikt C, Naperiela Mavedzenge S, Wong-Gruenwald R, Hanisch D, Magure T, Mugurungi O,Cowan FM.
1*Centre for Evaluation, London School of Hygiene &
Tropical Medicine, London, United Kingdom; †Centre for Sexual Health &
HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe; ‡United Nations
Population Fund, New York, NY; §Women's Global Health Imperative, RTI
International, San Francisco, CA; ‖Gesellschaft für Internationale
Zusammenarbeit, Bonn, Germany; National AIDS Council, Harare, Zimbabwe; #AIDS
and TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe; and
**Research Department for Infection and Population Health, University College London,
London, United Kingdom.
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