HIV prevention and care services for female sex workers: efficacy of a targeted community‐based intervention in Burkina Faso

Abstract

IntroductionAlthough interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso.MethodsBetween September 2009 and September 2011 we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months. The intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. We compared the cohort HIV incidence with a modelled expected incidence in the study population in the absence of intervention, using data collected at the same time from FSW clients.ResultsThe 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01–5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients (adjusted odds ratio (aOR)=2.19; 95% CI, 1.16–4.14, p=0.01) and with regular clients (aOR=2.18; 95% CI, 1.26–3.76, p=0.005).ConclusionsCombining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.

Review of HIV Interventions among Young and Adolescent Key Populations in Low to Middle Income Countries

“…The project adopted behavior change communication strategies, condom promotion and social marketing, care and management of STI clinics which led to an increase in awareness of STIs, use of condoms and decline in the prevalence of STIs. This finding can be corroborated with other studies conducted in Burkino Faso and China which also adopted community based interventions using peer based prevention and care, educational sessions and condom promotion that reduced the HIV incidence among young FSWs [28,29]. Community empowerment, condom promotion, HIV testing and counseling (HTC) with linkage to treatment and care services, STI treatment and health education have shown to be effective interventions for sex workers, but they have not been taken to scale or adequately resourced in most parts of the world [30].…”

Achieving the first 90 for key populations in sub‐Saharan Africa through venue‐based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola

“…A basic service package could include: HTS, outreach HIV prevention education, free condoms and lubricant, STI and TB screening and treatment, and peer navigator support to help newly HIV‐diagnosed KP link to care and initiate ART . Such a package echoes ongoing efforts to reach KP in SSA . While the cost‐effectiveness of such services requires further investigation, modelling data suggest that simply focusing HIV prevention interventions on the places and populations with highest risk could advert thousands of new infections without requiring additional resourcing .…”

“…Since 2014, the PEPFAR‐funded LINKAGES project has partnered with KP communities throughout SSA, including in five southern African countries, Malawi and Angola among them, to improve KP access to HIV prevention, treatment, and care . Following WHO guidance, LINKAGES and other KP implementing partners have introduced programmes that involve KP as providers, such as KP peer educators and outreach workers, and deliver stigma‐free HIV services closer to KP communities . Emerging evidence suggests KP programmes incorporating such outreach activities may hold promise for engaging HIV‐negative KP to prevent HIV acquisition and for accelerating HIV diagnosis and linkage to care for HIV‐positive KP .…”

HIV risk and behaviour among part-time versus professional FSW: baseline report of an interventional cohort in Burkina Faso: Table 1

“…The procedures used during the screening visit were identical as those from the interventional cohort described and published elsewhere 4. In addition to HIV, HSV-2 serologies and detection of vaginal infections ( Trichomonas vaginalis , Candida and bacterial vaginosis), serological syphilis was detected using a semiquantitative Rapid Plasma Reagin card test (Macro-Vue, Becton-Dickinson, Cockysville, Maryland, USA) and the Treponema pallidum Haemagglutination assay test (Welcosyph HA, Murex Biotech, Dartford, UK).…”