How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis

Elizabeth Fearon, Andrew Phillips, Sibongile Mtetwa, Sungai T. Chabata, Phillis Mushati, Valentina Cambiano, Joanna Busza, Sue Napierala, Bernadette Hensen, Stefan Baral, Sharon S. Weir, Brian Rice, Frances M. Cowan, James R. Hargreaves

Research output: Contribution to journalArticle

Abstract

BACKGROUND: "HIV prevention cascades" have been proposed to support programs by identifying gaps in demand for, access to, and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers. SETTING: Seven sites across Zimbabwe. METHODS: Seven respondent-driven sampling surveys from the intervention sites of a pragmatic cluster-randomized trial in Zimbabwe in 2016 were analyzed, and 611/1439 women testing HIV-negative included. We operationalized key components of an HIV prevention cascade including demand, supply, and capability to adhere to 2 tools for HIV prevention: condoms and pre-exposure prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other. RESULTS: There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. Although women were aware that condoms prevented HIV and reported good access to them, only 45·5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all 3 domains of demand, supply, and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day. CONCLUSIONS: HIV prevention programming among female sex workers in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women.

Original languageEnglish (US)
Pages (from-to)24-35
Number of pages12
JournalJournal of acquired immune deficiency syndromes (1999)
Volume81
Issue number1
DOIs
StatePublished - May 1 2019

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Zimbabwe
Sex Workers
Condoms
HIV Infections
HIV
Alcohols
Sex Work
HIV-2
Pre-Exposure Prophylaxis
Logistic Models
Technology

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis. / Fearon, Elizabeth; Phillips, Andrew; Mtetwa, Sibongile; Chabata, Sungai T.; Mushati, Phillis; Cambiano, Valentina; Busza, Joanna; Napierala, Sue; Hensen, Bernadette; Baral, Stefan; Weir, Sharon S.; Rice, Brian; Cowan, Frances M.; Hargreaves, James R.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 81, No. 1, 01.05.2019, p. 24-35.

Research output: Contribution to journalArticle

Fearon, E, Phillips, A, Mtetwa, S, Chabata, ST, Mushati, P, Cambiano, V, Busza, J, Napierala, S, Hensen, B, Baral, S, Weir, SS, Rice, B, Cowan, FM & Hargreaves, JR 2019, 'How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis', Journal of acquired immune deficiency syndromes (1999), vol. 81, no. 1, pp. 24-35. https://doi.org/10.1097/QAI.0000000000001980
Fearon, Elizabeth ; Phillips, Andrew ; Mtetwa, Sibongile ; Chabata, Sungai T. ; Mushati, Phillis ; Cambiano, Valentina ; Busza, Joanna ; Napierala, Sue ; Hensen, Bernadette ; Baral, Stefan ; Weir, Sharon S. ; Rice, Brian ; Cowan, Frances M. ; Hargreaves, James R. / How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 81, No. 1. pp. 24-35.
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AU - Mushati, Phillis

AU - Cambiano, Valentina

AU - Busza, Joanna

AU - Napierala, Sue

AU - Hensen, Bernadette

AU - Baral, Stefan

AU - Weir, Sharon S.

AU - Rice, Brian

AU - Cowan, Frances M.

AU - Hargreaves, James R.

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N2 - BACKGROUND: "HIV prevention cascades" have been proposed to support programs by identifying gaps in demand for, access to, and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers. SETTING: Seven sites across Zimbabwe. METHODS: Seven respondent-driven sampling surveys from the intervention sites of a pragmatic cluster-randomized trial in Zimbabwe in 2016 were analyzed, and 611/1439 women testing HIV-negative included. We operationalized key components of an HIV prevention cascade including demand, supply, and capability to adhere to 2 tools for HIV prevention: condoms and pre-exposure prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other. RESULTS: There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. Although women were aware that condoms prevented HIV and reported good access to them, only 45·5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all 3 domains of demand, supply, and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day. CONCLUSIONS: HIV prevention programming among female sex workers in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women.

AB - BACKGROUND: "HIV prevention cascades" have been proposed to support programs by identifying gaps in demand for, access to, and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers. SETTING: Seven sites across Zimbabwe. METHODS: Seven respondent-driven sampling surveys from the intervention sites of a pragmatic cluster-randomized trial in Zimbabwe in 2016 were analyzed, and 611/1439 women testing HIV-negative included. We operationalized key components of an HIV prevention cascade including demand, supply, and capability to adhere to 2 tools for HIV prevention: condoms and pre-exposure prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other. RESULTS: There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. Although women were aware that condoms prevented HIV and reported good access to them, only 45·5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all 3 domains of demand, supply, and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day. CONCLUSIONS: HIV prevention programming among female sex workers in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women.

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