The HIV care continuum among female sex workers: A key population in Lilongwe, Malawi

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

Research output: Contribution to journalArticle

Abstract

Objective The 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. Methods From 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. Results HIV 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. Conclusions FSW 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 FSWin Malawi must be strongly considered.

Original languageEnglish (US)
Article numbere0147662
JournalPLoS One
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Malawi
Sex Workers
Continuity of Patient Care
HIV
gender
Testing
Population
risk behavior
Blood
Risk-Taking
viral load
Viral Load
Health
Sampling
testing
HIV Seroprevalence
sociodemographic characteristics
Africa South of the Sahara
Sub-Saharan Africa
CD4 Lymphocyte Count

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Lancaster, K. E., Powers, K. A., Lungu, T., Mmodzi, P., Hosseinipour, M. C., Chadwick, K., ... Miller, W. C. (2016). The HIV care continuum among female sex workers: A key population in Lilongwe, Malawi. PLoS One, 11(1), [e0147662]. https://doi.org/10.1371/journal.pone.0147662

The HIV care continuum among female sex workers : A key population in Lilongwe, Malawi. / Lancaster, Kathryn Elizabeth; Powers, Kimberly A.; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C.; Chadwick, Katy; Go, Vivian F.; Pence, Brian W.; Hoffman, Irving F.; Miller, William C.

In: PLoS One, Vol. 11, No. 1, e0147662, 01.01.2016.

Research output: Contribution to journalArticle

Lancaster, KE, Powers, KA, Lungu, T, Mmodzi, P, Hosseinipour, MC, Chadwick, K, Go, VF, Pence, BW, Hoffman, IF & Miller, WC 2016, 'The HIV care continuum among female sex workers: A key population in Lilongwe, Malawi', PLoS One, vol. 11, no. 1, e0147662. https://doi.org/10.1371/journal.pone.0147662
Lancaster KE, Powers KA, Lungu T, Mmodzi P, Hosseinipour MC, Chadwick K et al. The HIV care continuum among female sex workers: A key population in Lilongwe, Malawi. PLoS One. 2016 Jan 1;11(1). e0147662. https://doi.org/10.1371/journal.pone.0147662
Lancaster, Kathryn Elizabeth ; Powers, Kimberly A. ; Lungu, Thandie ; Mmodzi, Pearson ; Hosseinipour, Mina C. ; Chadwick, Katy ; Go, Vivian F. ; Pence, Brian W. ; Hoffman, Irving F. ; Miller, William C. / The HIV care continuum among female sex workers : A key population in Lilongwe, Malawi. In: PLoS One. 2016 ; Vol. 11, No. 1.
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abstract = "Objective The 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. Methods From 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. Results HIV 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. Conclusions FSW 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 FSWin Malawi must be strongly considered.",
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N2 - Objective The 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. Methods From 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. Results HIV 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. Conclusions FSW 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 FSWin Malawi must be strongly considered.

AB - Objective The 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. Methods From 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. Results HIV 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. Conclusions FSW 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 FSWin Malawi must be strongly considered.

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