Long term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa

Abstract

BackgroundConcerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.MethodsProspective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events.Results95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/μl (IQR, 79-183) and 144 cells/μl (100-197), and the mean PVLs were 4.94 log10copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/μl (IQR, 90-400) in FSWs vs. 284 cells/μl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs.ConclusionsClinical and biological benefits of HAART can be maintained over the long term among FSWs in Africa and could also lead to important public health benefits.

Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study

“…These factors can impede daily medication regimes and access to conventional ART clinics due to avoidance of police, violent predators or partners, and working late night hours and away from health services 21. At the same time, data suggest that where programmes can address these gaps in retention, SW can have the same clinical and biological outcomes as other key affected populations 22. Ongoing drug use and poverty may also indirectly prevent SW from achieving optimal ART adherence 20 21.…”

“…Prior studies have documented the value of a multidisciplinary approach to adherence support for SW and DU, including close follow-up with a peer health advocate and outreach team as well as collective support from peer educators, physicians and other healthcare workers 22 26. Peer and sex work-led models, such as the San Francisco Occupational Health and Safety clinic,27 and the Songachi model in India,28 have been shown to reduce stigma and barriers to healthcare and increase trust with service providers that could promote increased retention in HIV care.…”

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

“…The intervention consisted of peer-led education sessions, free provision of STI syndromic management, condoms and hormonal contraceptives, psychological support and free general medical and HIV care (for those HIV infected at screening or seroconverting within the study period) [17, 18]. Peer-led education sessions were conducted every day at the study clinic and weekly in the sex work venues, addressing seven themes including HIV testing, STI diagnosis and treatment, genital herpes, condom use, condom negotiation, family planning and drug adherence.…”

“…Because secondary prevention of HIV infection through treatment has become crucial to impact the HIV transmission dynamics [14–16], dedicated services with tailored support for antiretroviral therapy (ART) adherence are likely to improve access to care, therapeutic success and prevention of secondary transmission of HIV, including with resistant viruses [17, 18]. …”

“…Our group showed that such an approach, with a strong community involvement, helped in achieving high rates of virological and immunological success of ART [17] with a major impact on infectiousness for sexual transmission [15], but, so far, no data are available on the impact of such a combined intervention on HIV incidence, particularly among young FSW who have recently started commercial sex. The evaluation of such combined intervention is complex.…”