Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study

ObjectivesWhile female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial.MethodsFSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti.ResultsFSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV.ConclusionsConsidering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

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Facilitators and barriers to incorporating digital technologies into HIV care among cisgender female sex workers living with HIV in South Africa

mHealth ◽

10.21037/mhealth.2019.12.07 ◽

2020 ◽

Vol 6 ◽

pp. 15-15 ◽

Cited By ~ 1

Author(s):

William X. You ◽

Carly A. Comins ◽

Brooke A. Jarrett ◽

Katherine Young ◽

Vijayanand Guddera ◽

...

Keyword(s):

South Africa ◽

Sex Workers ◽

Female Sex Workers ◽

Digital Technologies ◽

Hiv Care ◽

Female Sex ◽

Facilitators And Barriers ◽

Living With Hiv

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The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05742-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Roxanna Haghighat ◽

Elona Toska ◽

Nontuthuzelo Bungane ◽

Lucie Cluver

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Care ◽

Loss To Follow Up ◽

Hiv Care Cascade ◽

Care Cascade ◽

Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

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Pregnancy Intentions and Safer Pregnancy Knowledge Among Female Sex Workers in Port Elizabeth, South Africa

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001471 ◽

2016 ◽

Vol 128 (1) ◽

pp. 15-21 ◽

Cited By ~ 10

Author(s):

Amrita Rao ◽

Stefan Baral ◽

Nancy Phaswana-Mafuya ◽

Andrew Lambert ◽

Zamakayise Kose ◽

...

Keyword(s):

South Africa ◽

Sex Workers ◽

Female Sex Workers ◽

Pregnancy Intentions ◽

Female Sex ◽

Port Elizabeth

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High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda

International Journal of STD & AIDS ◽

10.1177/0956462418804658 ◽

2018 ◽

Vol 30 (3) ◽

pp. 275-283 ◽

Cited By ~ 1

Author(s):

Shira M Goldenberg ◽

Godfrey Muzaaya ◽

Monica Akello ◽

Melissa Braschel ◽

Josephine Birungi ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Infections ◽

Hiv Care ◽

Northern Uganda ◽

Negatively Associated ◽

Hiv Care Cascade ◽

Female Sex ◽

Cascade Of Care

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.

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