Evaluating the vertical HIV transmission risks among South African female sex workers; Have we forgotten PMTCT in their HIV programming?

Jean Olivier Twahirwa Rwema, Stefan Baral, Sosthenes Ketende, Nancy Phaswana-Mafuya, Andrew Lambert, Zamakayise Kose, Mfezi McIngana, Amrita Rao, Harry Hausler, Sheree Schwartz

Research output: Contribution to journalArticle

Abstract

Background: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. Methods: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Results: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV. Conclusion: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.

Original languageEnglish (US)
Article number605
JournalBMC public health
Volume19
DOIs
StatePublished - May 29 2019

Fingerprint

Sex Workers
Mothers
HIV
South Africa
Pregnancy
Sex Work
Reproductive History
Reproductive Health
Condoms
Child Care
Breast Feeding
Contraception

Keywords

  • Female sex workers
  • PMTCT
  • South Africa
  • Vertical transmission

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Evaluating the vertical HIV transmission risks among South African female sex workers; Have we forgotten PMTCT in their HIV programming? / Twahirwa Rwema, Jean Olivier; Baral, Stefan; Ketende, Sosthenes; Phaswana-Mafuya, Nancy; Lambert, Andrew; Kose, Zamakayise; McIngana, Mfezi; Rao, Amrita; Hausler, Harry; Schwartz, Sheree.

In: BMC public health, Vol. 19, 605, 29.05.2019.

Research output: Contribution to journalArticle

Twahirwa Rwema, Jean Olivier ; Baral, Stefan ; Ketende, Sosthenes ; Phaswana-Mafuya, Nancy ; Lambert, Andrew ; Kose, Zamakayise ; McIngana, Mfezi ; Rao, Amrita ; Hausler, Harry ; Schwartz, Sheree. / Evaluating the vertical HIV transmission risks among South African female sex workers; Have we forgotten PMTCT in their HIV programming?. In: BMC public health. 2019 ; Vol. 19.
@article{79fd675e123a4edf91cbbaedcda0542e,
title = "Evaluating the vertical HIV transmission risks among South African female sex workers; Have we forgotten PMTCT in their HIV programming?",
abstract = "Background: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. Methods: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Results: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5{\%} (95{\%} bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42{\%} in consistent condom use with clients among HIV-negative FSW and 43{\%} in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85{\%} (86/101) had their children tested for HIV after birth, but only 36{\%} (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35{\%}, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45{\%}) of mothers with children < 5 years (45/101) were on ART and 12{\%} (12/101) reported at least one child under five living with HIV. Conclusion: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.",
keywords = "Female sex workers, PMTCT, South Africa, Vertical transmission",
author = "{Twahirwa Rwema}, {Jean Olivier} and Stefan Baral and Sosthenes Ketende and Nancy Phaswana-Mafuya and Andrew Lambert and Zamakayise Kose and Mfezi McIngana and Amrita Rao and Harry Hausler and Sheree Schwartz",
year = "2019",
month = "5",
day = "29",
doi = "10.1186/s12889-019-6811-4",
language = "English (US)",
volume = "19",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Evaluating the vertical HIV transmission risks among South African female sex workers; Have we forgotten PMTCT in their HIV programming?

AU - Twahirwa Rwema, Jean Olivier

AU - Baral, Stefan

AU - Ketende, Sosthenes

AU - Phaswana-Mafuya, Nancy

AU - Lambert, Andrew

AU - Kose, Zamakayise

AU - McIngana, Mfezi

AU - Rao, Amrita

AU - Hausler, Harry

AU - Schwartz, Sheree

PY - 2019/5/29

Y1 - 2019/5/29

N2 - Background: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. Methods: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Results: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV. Conclusion: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.

AB - Background: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. Methods: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Results: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV. Conclusion: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.

KW - Female sex workers

KW - PMTCT

KW - South Africa

KW - Vertical transmission

UR - http://www.scopus.com/inward/record.url?scp=85066399495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066399495&partnerID=8YFLogxK

U2 - 10.1186/s12889-019-6811-4

DO - 10.1186/s12889-019-6811-4

M3 - Article

VL - 19

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

M1 - 605

ER -