CHICAGO – Presentations this morning highlighted efforts to reach female sex workers with data from studies in South Africa, Rwanda and Kenya that provided HIV self-testing, antiretroviral treatment, pre-exposure prophylactic use of antiretroviral drugs — PrEP — and other services.
In a South Africa study looking at the feasibility and cost-effectiveness of engaging female sex workers in immediate treatment or PrEP, of 627 women tested for HIV, 30 percent of those who tested negative chose to use PrEP and 19 percent of those who tested HIV positive took up treatment. During the first year of the study, 70 percent of those on treatment remained in care and 51 percent of those using PrEP remained engaged. All of those taking PrEP remained uninfected, and treatment remained effective for all of the women receiving it. Most of the participants were married or living with a steady partner and reported unchanged condom use — high with clients, and low with partners. The cost of the program over the first year was $105 per participant for PrEP and $311 per participant for treatment.
A test-and-treat program in Kigali, Rwanda used peer educators to approach sex workers in areas of the city where they worked and provide them with vouchers they could use at nearby health centers to access a range of services including HIV testing, antiretroviral therapy, viral load testing for those already on treatment, and family planning services. Almost all of the 913 women who presented at health clinics with vouchers had already been HIV tested. HIV prevalence among the group was 44 percent, and of the 362 women who were already aware of their positive status, 92 percent were on antiretroviral therapy and 80 percent of those were virally suppressed. Of the 70 women newly identified as HIV-infected 62 percent agreed to initiate HIV treatment. The study authors hope the program will be more widely implemented in Kigali and elsewhere in the country.
In Kenya, a program in several high HIV prevalence areas of the country added oral HIV self-testing to the services offered by peer educators to female sex workers in already existing drop-in centers for sex workers and other underserved populations to evaluate the acceptability of the method and its impact on participation in prevention and treatment programs. Criteria for participation in the study included being at least 18 years old and either never having been HIV tested since beginning sex work or not having been tested in the last six months. Sex workers were asked to follow up at clinic sites for confirmatory tests, where they could also access appropriate prevention and treatment services. Of the women who used the oral self test, 84 percent confirmed their results at a health care facility and 8 percent received confirmed HIV diagnoses and were linked to treatment.