Community-based antiretroviral therapy (ART) delivery for female sex workers in Tanzania: intervention model and baseline findings

ABSTRACT

To increase linkage to and retention in antiretroviral therapy (ART) care, we piloted a community-based, ART service delivery intervention for female sex workers (FSWs). At baseline, we recruited and collected data from 617 FSWs (intervention: 309; comparison: 308) who were HIV positive and not on ART. This paper presents (1) the description of the intervention model, and (2) key descriptive and bivariate-level findings of the baseline FSW cohort. The data showed more than half of FSWs had a non-paying sex partner, and less than one-third used a condom at last sex with paying and non-paying clients, which suggest potentially high levels of HIV transmission. In addition, there is a gap in HIV testing and treatment because one-third learned about their HIV-positive status only at study enrollment, and among FSWs who had known their status for more than a month, half had not registered in care. This substantiates the importance of timely HIV diagnosis and treatment. A community-based ART program may serve as an important strategy in closing the HIV care and treatment gap for FSWs.

KEYWORDS:

• Community-based ART
• linkages
• retention
• female sex workers (FSW)
• 90-90-90
• Tanzania

Acknowledgements

We would like to specially thank Hally Mahler (FHI360) for her contribution to the development of the study concept, and Albert Komba (Jhpiego) for his contribution to the study concept and strong support during implementation. This study would not have been possible without the NIMR research team, including John Changalucha, Catherine Bunga, Erick Mgina, and Charles Mangya. We greatly appreciate the work of our Jhpiego colleagues who assisted with the implementation of the ART model, and all the nurses, counselors, peer educators and study participants.LV and WT conceived the research design. LV, WT, CC, NM, EM conceived the intervention design (ART model). CC, LA, LV and WT refined the intervention design. LV and WT conducted data analysis and drafted the manuscript. LA oversaw fieldwork and managed M&E data. LA and DM monitored data collection. CC drafted the intervention description. ST contributed to literature review and drafted the introduction and result. All authors provided critical review and comments.

Disclosure statement

No potential conflict of interest was reported by the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This study is made possible by the generous support of the American people through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) with the United States Agency for International Development (USAID) under the Cooperative Agreement Project SOAR (Supporting Operational AIDS Research), number [AID-OAA-14-00060]. The findings and recommendations of this study are those of the authors and do not reflect the views of USAID or the government of Tanzania.