Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: Findings from a respondent-driven sampling study

Sheree Schwartz, Andrew Lambert, Nancy Phaswana-Mafuya, Zamakayise Kose, Mfezi Mcingana, Claire Holland, Sosthenes Ketende, Clarence Yah, Stephanie Sweitzer, Harry Hausler, Stefan Baral

Research output: Contribution to journalArticle

Abstract

Background Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use. Methods FSWs ≤18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression. Results Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven samplingweighted prevalence 61.5% (95% bootstrapped CI 54.1% to 68.0%)). Prior diagnosis of HIV was relatively high (214/261, 82%); however, ART coverage among FSWs living with HIV was 39% (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to nonpaying partners (adjusted prevalence ratio (aPR) 0.43, 95% CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95% CI 0.57 to 0.89). Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.

Original languageEnglish (US)
JournalSexually Transmitted Infections
DOIs
StateAccepted/In press - Nov 25 2016

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Sampling Studies
Sex Workers
South Africa
HIV
Therapeutics
Surveys and Questionnaires
Syphilis
CD4 Lymphocyte Count

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

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Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa : Findings from a respondent-driven sampling study. / Schwartz, Sheree; Lambert, Andrew; Phaswana-Mafuya, Nancy; Kose, Zamakayise; Mcingana, Mfezi; Holland, Claire; Ketende, Sosthenes; Yah, Clarence; Sweitzer, Stephanie; Hausler, Harry; Baral, Stefan.

In: Sexually Transmitted Infections, 25.11.2016.

Research output: Contribution to journalArticle

Schwartz, Sheree ; Lambert, Andrew ; Phaswana-Mafuya, Nancy ; Kose, Zamakayise ; Mcingana, Mfezi ; Holland, Claire ; Ketende, Sosthenes ; Yah, Clarence ; Sweitzer, Stephanie ; Hausler, Harry ; Baral, Stefan. / Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa : Findings from a respondent-driven sampling study. In: Sexually Transmitted Infections. 2016.
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abstract = "Background Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use. Methods FSWs ≤18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression. Results Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven samplingweighted prevalence 61.5{\%} (95{\%} bootstrapped CI 54.1{\%} to 68.0{\%})). Prior diagnosis of HIV was relatively high (214/261, 82{\%}); however, ART coverage among FSWs living with HIV was 39{\%} (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to nonpaying partners (adjusted prevalence ratio (aPR) 0.43, 95{\%} CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95{\%} CI 0.57 to 0.89). Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.",
author = "Sheree Schwartz and Andrew Lambert and Nancy Phaswana-Mafuya and Zamakayise Kose and Mfezi Mcingana and Claire Holland and Sosthenes Ketende and Clarence Yah and Stephanie Sweitzer and Harry Hausler and Stefan Baral",
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T1 - Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa

T2 - Findings from a respondent-driven sampling study

AU - Schwartz, Sheree

AU - Lambert, Andrew

AU - Phaswana-Mafuya, Nancy

AU - Kose, Zamakayise

AU - Mcingana, Mfezi

AU - Holland, Claire

AU - Ketende, Sosthenes

AU - Yah, Clarence

AU - Sweitzer, Stephanie

AU - Hausler, Harry

AU - Baral, Stefan

PY - 2016/11/25

Y1 - 2016/11/25

N2 - Background Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use. Methods FSWs ≤18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression. Results Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven samplingweighted prevalence 61.5% (95% bootstrapped CI 54.1% to 68.0%)). Prior diagnosis of HIV was relatively high (214/261, 82%); however, ART coverage among FSWs living with HIV was 39% (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to nonpaying partners (adjusted prevalence ratio (aPR) 0.43, 95% CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95% CI 0.57 to 0.89). Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.

AB - Background Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use. Methods FSWs ≤18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression. Results Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven samplingweighted prevalence 61.5% (95% bootstrapped CI 54.1% to 68.0%)). Prior diagnosis of HIV was relatively high (214/261, 82%); however, ART coverage among FSWs living with HIV was 39% (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to nonpaying partners (adjusted prevalence ratio (aPR) 0.43, 95% CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95% CI 0.57 to 0.89). Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.

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