Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015

Abstract

Introduction‘Sisters with a Voice’, Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation.MethodsWe used mixed methods to collect data at three sites: in‐depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer‐administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS‐1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education.Results870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio‐demographic differences, we found higher estimates of the proportion of HIV‐positive FSWs and HIV‐positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV‐negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites.ConclusionsImprovements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90‐90‐90 targets.

Building the evidence base to optimize the impact of key population programming across the HIV cascade

“…Ndori‐Mharadze et al . report results from an evaluation of ‘Sisters with a Voice’, Zimbabwe's nationally scaled comprehensive programme for FSWs, following intensified community mobilization activities . The findings demonstrate that early peer mobilization efforts to familiarize community members with tailored HIV services were associated with improved outcomes, notably increases in HIV testing frequency, knowledge of HIV status and increased linkage to ART.…”

Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda

“…Similar interactive sessions have been credited by FSWs in Zimbabwe for improving awareness of self-care as well as prevention and treatment of HIV and STIs. 19 Also, during ongoing risk-reduction counseling sessions in our study, participants are motivated to improve or maintain healthy behaviors. This motivation may not only facilitate the adoption of healthy behaviors but also influence participants to regularly attend the clinic.…”

“…Intensified peer outreach is associated with improved clinic utilization among FSWs and may be particularly important among isolated groups such as street-based FSWs. [19][20][21] We note some key limitations. The measurement of MSV and seroconversion within the same episode could lead to some misclassification for the timing of seroconversions in the episodes with MSV if seroconversion occurred earlier before the missed visits.…”

“…14,15 At the same time, these key determinants of service utilization are also important risk factors for HIV infection among FSWs. [18][19][20] Although there is growing interest in improving service utilization among FSWs, it remains unclear how recent levels of service attendance are associated with subsequent HIV risk. 14,19,20 Using the proportions of study visits completed, research has linked reduced incidence of HIV and other STIs among FSWs to amount of exposure to targeted HIV interventions such as peer-mediated HIV education, condom promotion, risk-reduction interventions, and presumptive treatment for STIs.…”

“…[18][19][20] Although there is growing interest in improving service utilization among FSWs, it remains unclear how recent levels of service attendance are associated with subsequent HIV risk. 14,19,20 Using the proportions of study visits completed, research has linked reduced incidence of HIV and other STIs among FSWs to amount of exposure to targeted HIV interventions such as peer-mediated HIV education, condom promotion, risk-reduction interventions, and presumptive treatment for STIs. [21][22][23] However, assessment of the HIV risk associated with previous recent levels of service attendance may offer better evidence for risk associated with intervention exposure because an individual's level of attendance can vary over time and for different reasons.…”