20th International AIDS Conference - Melbourne, Australia


THAC0305LB - Oral Abstract

Estimation of the HIV care cascade for female sex workers in Zimbabwe: baseline results of the SAPPH-Ire trial

Presented by Frances M Cowan (United Kingdom).

F.M. Cowan1,2, C. Davey3, S. Napierala Mavedzenge4, P. Mushati2, S. Mtetwa2, T. Chiyaka2, V. Cambiano1, N. Masuka5, M. Chemhuru6, O. Mugurungi7, D. Hanisch8, K. Hatzold9, J. Busza10, A. Phillips1, J. Hargreaves3

1University College London, Research Department of Infection and Population Health, London, United Kingdom, 2Centre for Sexual Health HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe, 3London School of Hygiene and Tropical Medicine, Public Health Policy, London, United Kingdom, 4RTI International, Women's Global Health Imperative, San Francisco, United States, 5Ministry of Health and Child Care, Bulawayo, Zimbabwe, 6Ministry of Health and Child Care, Gweru, Zimbabwe, 7Ministry of Health and Child Care, Harare, Zimbabwe, 8UNFPA, Harare, Zimbabwe, 9PSI Zimbabwe, Harare, Zimbabwe, 10London School of Hygiene and Tropical Medicine, London, United Kingdom

Background: Female sex workers (FSW) in Zimbabwe have high HIV prevalence (50-70%) but are not optimally engaged in prevention and care. We estimate the HIV care cascade, using data collected in a baseline survey of a trial of ART for prevention among FSW in Zimbabwe”
Methods: The SAPPH-IRE trial is a matched-pair, cluster-randomized trial of ART for prevention among FSW in Zimbabwe conducted in 14 communities. The primary outcome is the proportion of all FSW with detectable viral load (VL>1000 copies/ml). The ''usual care'' Sisters'' program provides free HIV testing, contraception, condoms, STI syndromic management and referral to government ART services for HIV+,, all supported by peer educators. The ''enhanced SAPPH-Ire intervention'' provides ''usual care'' plus onsite ART, offer of PrEP for HIV-, repeat testing, intensified community mobilization and ART/TB treatment adherence support. A baseline survey was conducted in December 2013 using respondent driven sampling (RDS). Weighted summaries were calculated (Stata12 RDS analysis package).
Results: 2,722 FSWs were recruited (mean age 32 years; range 18-65). Few were married (1%); 63% were separated/divorced. 18% (95%CI 8-28%) reported starting sex work before age 18 and 37.4% (95%CI 17.3-59.1%) reported intimate partner violence. HIV prevalence was 56% (95%CI 50-63) with 61% of HIV+ FSW diagnosed. Among HIV+ FSW, 40% reported taking ART with 31% reporting taking ART having an undetectable VL. A further 14% of HIV+ FSW had undetectable VL despite not reporting being on ART. Considering the trial primary outcome 29% (95%CI 25-34%) of all FSW had detectable viral load.
Conclusions: Treatment uptake among FSW has increased since 2011 when only 25-35% of HIV+ FSW were on ART, HIV prevalence remains high and further progress is required to increase uptake of testing, treatment and prevention. This trial will estimate the impact and cost-effectiveness of ART for prevention for FSW in Zimbabwe.

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