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Estimation of the HIV care cascade for female sex workers in Zimbabwe: Baseline results of the SAPPH-IRe Trial. Frances M Cowan. Collaborative project. Zimbabwe Ministry of Health and Child Care and Centre for Sexual Health and HIV AIDS Research, Zimbabwe, - PowerPoint PPT Presentation
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Estimation of the HIV care cascade for female sex workers in Zimbabwe:
Baseline results of the SAPPH-IRe Trial
Frances M Cowan
Collaborative project
Zimbabwe Ministry of Health and Child Care and Centre for Sexual Health and HIV AIDS
Research, Zimbabwe,
in collaboration with UNFPA, PSI Zimbabwe, the National AIDS Council, University College London, the London School of Hygiene and
Tropical Medicine, and RTI International.
Established in 2009 with five sites- expanded in 2013 to 36 sites nationally
Developed in close consultation with SWs and other stakeholders
‘Sisters with a Voice’
• Clinical services
• Supported by 130 peer educators (50% paralegals)
• Community mobilisation
• >17,800 SW seen
‘Sisters’ services
– Health education– Safer sex counseling– Free male and female condoms– HIV testing and counseling– Referral to treatment and care for HIV positive women– Syndromic management of STIs– Contraception
Overview of trial design
Conduct baseline survey using RDS in 14 outreach sitesRecruit ≈ 200 SWs per site (total n=2,800 )
Usual Care SitesHealth education, HTC Referral to government HIV care services as needed, Syndromic STI Contraception,CondomsCervical Ca screening,Legal advice
Random allocation of 7 matched sites to intervention arms
SAPPH-IRe Ix SitesUsual care plus:HIV negatives•Repeat HTC, Offer of PrEPHIV positives•PoC CD4; On site ARTIntensified community mobilisation with SMS adherence supportAdherence sisters program
After 18 months conduct endline survey using RDS in all 14 sites. Recruit ≈ 200 SWs per site (total n=2,800 )
Process E
valuationP
rogram data collection
Primary Outcome Secondary Outcomes
• Proportion of all SW who are infectious with HIV (viral load >1000 copies/ml).
• % HIV-infected SW who are infectious
• % on taking ART who have viral load >1000 who have drug resistance
• Self-reported QoL, psychological health and functioning
• % adherent to ART for treatment• % SWs always using condoms with
clients in last month• % of SWs who know HIV status• Perceived levels of peer support• % engaged in prevention/care)
appropriate to their individual place on the care continuum
Rapid mapping at each site
Seed selection • 8 at 4 sites, 6 at 10 sites
RDS Survey • Interviewer-administered on tablets• DBS for HIV Ab testing and Viral Load
Analysis• Weighted prevalence estimates accounting for RDS for
whole populations and sub-populations• Random effects regression to explore associations
Respondent Driven Sampling Survey
Baseline RDS survey results
Enrolment
• Survey conducted Nov 13 2013 to 20 Dec 2013
• Aimed to recruit 200 women each site
BINDURA 207CHINHOYI 220CHIPINGE 190CHIVHU 196GUTU 184GWANDA 153HWANGE 202JURU 197KADOMA 200KARIBA 202MAGUNJE 200MARONDERA 165NGUNDU 198ZVISHAVANE 208
Age at survey
Age n % (95% CIs) *
18-24 785 26.8 (16.2 - 37.3)25-29 673 22.1 (19.7 - 24.7)30-39 894 36.0 (28.6 - 41.7)>40 370 15.1 (9.0 - 19.8)Total 2722 100
* percents are RDS weighted
Age started sex workAge n % (95% CIs)*
<18 492 18.0 (8.4 - 28.1)18-19 173 6.0 (1.6 - 13.7)20-24 839 30.1 (21.2 - 42.1)25-29 650 23.0 (14.9 - 33.3)>30 568 22.8 (12.0 - 29.5)
* percents are RDS weighted
Behaviour - # clients last week
# clients last week n % (95% CIs)
None 200 6.9 (2.6 - 11.6)1-5 1352 52.6 (34.3 - 72.3)6-10 578 19.5 (11.0 - 33.1)11-15 218 6.3 (3.4 - 9.8) 16+ 374 14.7 (2.9 - 36.2)
* percents are RDS weighted
Overall HIV prevalence 56.4% (95% CI 42.2-80.0)
Age n % (95% CIs) *18-24 233/655 36% (26-46%)25-29 372/665 55% (48-62%)30-39 649/948 69% (60-73%)>40 345/440 77% (71-82%)Total 2722 100
* percents are RDS weighted
Consistent condom usewith clients
59.3 % (36.4 - 83.3)
Ever experienced IPV 37.4% (17.3 - 59.1)
Ever experienced Client BV 28.3% (10.8- 58.0)
Raped in last 12 months 4.3% (1.1-13.2)
Other attributes
* percents are RDS weighted
HIV Care Cascade
Percent
Cascade of care for HIV+ FSW in Zimbabwe
HIV + Diagnosed On ART Viral suppression< 1000 cps/mL
Additional 14%with viral suppressionreporting not on ART
100%
61%
40%31%
45%
maybe consider 95% CI’s since havegiven them throughout
100%
61%
40%
31%
50%
Additional 19% with viral suppression but reporting not on ART
In summary• Programmatic and past research data suggest
SWs are not adequately linked to services
• Analysis of baseline survey data suggests that service access is improving but still sub-optimal, particularly in terms of testing and diagnosis.
• Trial will provide evidence of cost effectiveness of strengthening ART provision for both prevention and treatment among SWs
AcknowledgementsCo Investigators• Joanna Busza - LSHTM• Valentina Cambiano - UCL• Dr Milton Chemhuru Provincial
Medical Director Midlands• Dagmar Hanisch -UNFPA • James Hargreaves LSHTM• Dr Nyasha Masuka PMD
Matebeleland North• Sue Mavedzenge RTI International• Dr Owen Mugurungi – Director
HIV AIDS and TB Unit, MoHCC• Andrew Phillips UCL• Professor Simba Rusakaniko UZ-
CHS
And Others• Valentina Cambiano UCL • Samson Chidiya – UNFPA• Tarisai Chinyaka – CeSHHAR• Calum Davey – LSHTM• Jeffrey Dirawo – CeSHHAR• Vimbai Mdege NAC• Sibongile Mtetwa - CeSHHAR • Sithembile Msembiri - CeSHHAR• Phillis Mushati - CeSHHAR• Basile Tambashe - Country
Representative UNFPA
