Community-Based Antiretroviral Therapy (ART) Delivery for Female Sex Workers in Tanzania: 6-Month ART Initiation and Adherence

W Tun,L Vu,C Casalini,T Koppenhaver,D Bikaru,L Apicella,K Jeremiah,G Mbita,N Makyao,E Mlanga

doi:10.1007/s10461-019-02549-x

Abstract

We conducted an implementation science study of a community-based ART distribution program for HIV-positive female sex workers (FSW) whereby clients received ART services through community-based mobile and home-based platforms. We compared 6-month treatment-related outcomes in the community-based ART arm (N = 256) to the standard facility-based ART delivery arm (N = 253). Those in the intervention arm were more likely to have initiated ART (100.0% vs. 71.5%; p = 0.04), be currently taking ART at the 6-month visit (100.0% vs. 95.0%; p < 0.01), and less likely to have stopped taking ART for more than 30 days continuously (0.9% vs. 5.7%; p = 0.008) or feel high levels of internalized stigma (26.6% vs. 39.9%; p = 0.001). In the adjusted regression model, internalized stigma (adjusted OR [aOR]: 0.5; 95% CI 0.28–0.83) and receiving community-based ART (aOR: 208.6; 95% CI 12.5–3479.0) were significantly associated with ART initiation. Community-based ART distribution model can improve linkage to and adherence to ART over standard facility-based ART programs for FSWs.

Highlights

Linkage to HIV care and treatment, retention in care, and attainment of viral suppression is a challenge for people living with HIV in Tanzania, as in many other resource-limited settings [1,2,3,4]
Evidence from studies with female sex workers (FSW) in Tanzania and other African countries have documented the challenges that FSWs face in accessing HIV care and treatment services, including difficulty reaching distant clinics, out-of-pocket costs associated with care, lack of knowledge and misperceptions of treatment, lack of respect for dignity and confidentiality, and persistent stigma associated with sex work and HIV [7,8,9,10]
This is the first study to report on the treatment outcomes after community-based distribution of antiretroviral therapy (ART) services to FSWs in Tanzania

Summary

Introduction

Linkage to HIV care and treatment, retention in care, and attainment of viral suppression is a challenge for people living with HIV in Tanzania, as in many other resource-limited settings [1,2,3,4]. A recent study among community-recruited FSWs in Tanzania indicated that 31% were previously aware of their HIV status, out of which 69% were on ART, and of those on ART, 70% were virally suppressed [18]. Evidence from studies with FSWs in Tanzania and other African countries have documented the challenges that FSWs face in accessing HIV care and treatment services, including difficulty reaching distant clinics, out-of-pocket costs associated with care, lack of knowledge and misperceptions of treatment, lack of respect for dignity and confidentiality, and persistent stigma associated with sex work and HIV [7,8,9,10]

Methods

Results

Discussion

Conclusion