Abstract
BackgroundConcerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.MethodsProspective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events.Results95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/μl (IQR, 79-183) and 144 cells/μl (100-197), and the mean PVLs were 4.94 log10copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/μl (IQR, 90-400) in FSWs vs. 284 cells/μl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs.ConclusionsClinical and biological benefits of HAART can be maintained over the long term among FSWs in Africa and could also lead to important public health benefits.
Highlights
Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy
Professional female sex workers (FSWs), alongside less visible groups involved in part-time transactional sex such as bar workers, mobile fruit sellers [12], represent an important core HIV transmitter group that plays a central role in the dynamics of HIV transmission in West Africa [13,14]
Between August 2004 and January 2005, women from local organizations of people living with HIV/AIDS (PLWHA) and from the University Hospital in Bobo-Dioulasso were recruited to participate in two trials of Herpes Simplex Virus (HSV) suppressive therapy [6,19], resulting in both FSWs and non-FSWs to form the cohort population
Summary
Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Several HIV prevention intervention programmes have targeted high-risk populations by providing access to condoms, promoting behaviour change and offering sexually transmitted infections (STI) care [16,17], but few programmes have provided HAART, because of the logistical difficulty of implementing complex programmes in these often marginalised and hard-to-reach populations, with perceived poor social or familial support for drug adherence. We hypothesised that this group would have a similar adherence to HAART as non-FSWs, and would have similar treatment outcomes, provided sufficient support is supplied by health care services and the community
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