The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi.

Kathryn Elizabeth Lancaster,Brian W Pence,Thandie Lungu,Irving F Hoffman,Vivian F Go,Mina C Hosseinipour,Kimberly A Powers,William C Miller,Pearson Mmodzi,Katy Chadwick

doi:10.1371/journal.pone.0147662

Abstract

ObjectiveThe HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi.MethodsFrom July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome.ResultsHIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22–28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3–17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes.ConclusionsFSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.

Highlights

HIV prevalence among female sex workers (FSW) remains disproportionately high despite decades of prevention activities.[1,2,3,4,5] Globally, the HIV prevalence among FSW is 12%, with a higher prevalence of 37% in sub-Saharan Africa
We calculated proportions of HIV-infected FSW who had history of care, were on Anti-retroviral therapy (ART), and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome
The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed

Summary

Introduction

HIV prevalence among female sex workers (FSW) remains disproportionately high despite decades of prevention activities.[1,2,3,4,5] Globally, the HIV prevalence among FSW is 12%, with a higher prevalence of 37% in sub-Saharan Africa. HIV-infected FSW have a higher number of sexual partners compared to other women of reproductive age, increasing the likelihood of HIV acquisition, as well as transmission to their clients.[1, 6] Effective interventions are clearly needed to reduce HIV acquisition and transmission among this key population. [7, 8] To experience these benefits of ART, HIV-infected persons must be diagnosed and receive HIV care and treatment. The HIV care continuum is a commonly used framework that provides cross-sectional descriptions of population-level engagement in HIV testing, care, and treatment.[9, 10] If HIV-infected FSW fail to attain optimal outcomes along this “HIV continuum,” they will not receive the clinical benefits of HIV care and treatment, and will likely continue to transmit HIV.[11, 12]

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Results

Conclusion