Estimation of the HIV care cascade for female sex workers in Zimbabwe: Baseline results of the SAPPH...
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Estimation of the HIV care cascade for female sex workers in Zimbabwe: Baseline results of the SAPPH-IRe Trial. Frances M Cowan. Collaborative project. Zimbabwe Ministry of Health and Child Care and Centre for Sexual Health and HIV AIDS Research, Zimbabwe,

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Frances m cowan

Estimation of the HIV care cascade for female sex workers in Zimbabwe: Baseline results of the SAPPH-IRe Trial

Frances M Cowan


Collaborative project

Collaborative project

Zimbabwe Ministry of Health and Child Care and Centre for Sexual Health and HIV AIDS Research, Zimbabwe,

in collaboration with UNFPA, PSI Zimbabwe, the National AIDS Council, University College London, the London School of Hygiene and Tropical Medicine, and RTI International.


Sisters with a voice

‘Sisters with a Voice’

Established in 2009 with five sites- expanded in 2013 to 36 sites nationally

Developed in close consultation with SWs and other stakeholders

  • Clinical services

  • Supported by 130 peer educators (50% paralegals)

  • Community mobilisation

  • >17,800 SW seen


Sisters services

‘Sisters’ services

  • Health education

  • Safer sex counseling

  • Free male and female condoms

  • HIV testing and counseling

  • Referral to treatment and care

    for HIV positive women

  • Syndromic management of STIs

  • Contraception


Frances m cowan

  • Overview of trial design


Frances m cowan

Conduct baseline survey using RDS in 14 outreach sites

Recruit ≈ 200 SWs per site (total n=2,800 )

Random allocation of 7 matched sites to intervention arms

Process Evaluation

Program data collection

  • SAPPH-IRe Ix Sites

  • Usual care plus:

  • HIV negatives

  • Repeat HTC, Offer of PrEP

  • HIV positives

  • PoC CD4; On site ART

  • Intensified community mobilisation with SMS adherence support

  • Adherence sisters program

Usual Care Sites

Health education, HTC

Referral to government HIV care services as needed,

Syndromic STI

Contraception,

Condoms

Cervical Ca screening,

Legal advice

After 18 months conduct endline survey using RDS in all 14 sites. Recruit ≈ 200 SWs per site (total n=2,800 )


Frances m cowan

Secondary Outcomes

Primary Outcome

Proportion of all SW who are infectious with HIV (viral load >1000 copies/ml).

% HIV-infected SW who are infectious

% on taking ART who have viral load >1000 who have drug resistance

Self-reported QoL, psychological health and functioning

% adherent to ART for treatment

% SWs always using condoms with clients in last month

% of SWs who know HIV status

Perceived levels of peer support

% engaged in prevention/care) appropriate to their individual place on the care continuum


Respondent driven sampling survey

Respondent Driven Sampling Survey

Rapid mapping at each site

Seed selection

  • 8 at 4 sites, 6 at 10 sites

    RDS Survey

    • Interviewer-administered on tablets

    • DBS for HIV Ab testing and Viral Load

      Analysis

      • Weighted prevalence estimates accounting for RDS for whole populations and sub-populations

      • Random effects regression to explore associations


Baseline rds survey results

Baseline RDS survey results


Enrolment

Enrolment

  • Survey conducted Nov 13 2013 to 20 Dec 2013

  • Aimed to recruit 200 women each site


Age at survey

Age at survey

  • * percents are RDS weighted


Age started sex work

Age started sex work

  • * percents are RDS weighted


Behaviour clients last week

Behaviour - # clients last week

  • * percents are RDS weighted


Overall hiv prevalence 56 4 95 ci 42 2 80 0

Overall HIV prevalence 56.4% (95% CI 42.2-80.0)

  • * percents are RDS weighted


Consistent condom use with clients

Consistent condom usewith clients

  • Other attributes

59.3 % (36.4 - 83.3)

  • Ever experienced IPV37.4% (17.3 - 59.1)

  • Ever experienced Client BV 28.3% (10.8- 58.0)

  • Raped in last 12 months4.3% (1.1-13.2)

  • * percents are RDS weighted


Hiv care cascade

HIV Care Cascade


Frances m cowan

  • 100%

  • maybe consider 95% CI’s since have

  • given them throughout

  • Additional 19% with viral suppression but reporting not on ART

  • 61%

  • 50%

  • 40%

  • 31%


In summary

In summary

  • Programmatic and past research data suggest SWs are not adequately linked to services

  • Analysis of baseline survey data suggests that service access is improving but still sub-optimal, particularly in terms of testing and diagnosis.

  • Trial will provide evidence of cost effectiveness of strengthening ART provision for both prevention and treatment among SWs


Acknowledgements

Acknowledgements

And Others

Valentina Cambiano UCL

Samson Chidiya – UNFPA

Tarisai Chinyaka – CeSHHAR

Calum Davey – LSHTM

Jeffrey Dirawo – CeSHHAR

Vimbai Mdege NAC

Sibongile Mtetwa - CeSHHAR

Sithembile Msembiri - CeSHHAR

Phillis Mushati - CeSHHAR

BasileTambashe - Country Representative UNFPA

Co Investigators

  • Joanna Busza - LSHTM

  • Valentina Cambiano - UCL

  • Dr Milton Chemhuru Provincial Medical Director Midlands

  • Dagmar Hanisch -UNFPA

  • James Hargreaves LSHTM

  • Dr Nyasha MasukaPMD MatebelelandNorth

  • Sue Mavedzenge RTI International

  • Dr Owen Mugurungi – Director HIV AIDS and TB Unit, MoHCC

  • Andrew Phillips UCL

  • Professor Simba Rusakaniko UZ-CHS


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