Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study
Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study
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DOI：
10.1136/sextrans-2016-052773
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发表时间：
2017-06-01
影响因子：
3.6
通讯作者：
Baral, Stefan
中科院分区：
文献类型：
--
作者：
Schwartz, Sheree;Lambert, Andrew;Baral, Stefan
背景 女性性工作者 (FSW) 受到艾滋病毒的影响尤为严重，即使是在南非等艾滋病毒广泛流行的背景下也是如此。尽管艾滋病毒治疗对个人和人群层面有好处，但仍然观察到了这一点。我们描述了 FSW 之间的 HIV 护理级联以及与抗逆转录病毒治疗 (ART) 使用的关系。方法通过受访者驱动的抽样招募了 18 岁以上的 FSW 进行南非伊丽莎白港的一项横断面研究。参与者填写了问卷并接受了艾滋病毒和梅毒检测；对感染艾滋病毒的女性的 CD4 计数进行了评估。描述了 HIV 护理级联的参与情况，并使用稳健的泊松回归估计了符合治疗资格的先前诊断的 FSW 中自我报告的 ART 使用的相关性。结果 2014 年 10 月至 2015 年 4 月期间，410 名 FSW 参与了研究活动。总体而言，261/410 人感染了 HIV（受访者驱动的抽样加权患病率为 61.5%（95% 自举置信区间为 54.1% 至 68.0%））。 HIV 既往诊断率相对较高（214/261，82%）；然而，艾滋病毒感染者的 ART 覆盖率为 39% (102/261)。在多变量分析中，如果 FSW 未向非付费伴侣披露其 HIV 状况（调整后患病率 (aPR) 0.43，95% CI 0.22 至 0.86，其中参考没有非付费伴侣的 FSW），并且如果他们参与流动医疗服务（aPR 0.71，95% CI 0.57 至 0.86），则 FSW 接受 ART 的可能性较小。 0.89）。结论 HIV 检测和对 HIV 状况的认识很高，但在治疗开始时发生了级联中的大量损失。鉴于参与移动艾滋病毒检测和同伴教育项目的女性工作人员未能满足艾滋病毒治疗需求，应评估分散治疗提供模式，例如基于移动的抗逆转录病毒疗法护理。
Background Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use.Methods FSWs >= 18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression.Results Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven sampling-weighted prevalence 61.5% (95% bootstrapped CI 54.1% to 68.0%)). Prior diagnosis of HIV was relatively high (214/261, 82%); however, ART coverage among FSWs living with HIV was 39% (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to non-paying partners (adjusted prevalence ratio (aPR) 0.43, 95% CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95% CI 0.57 to 0.89).Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.