Cohort analysis of programme data to estimate HIV incidence and uptake of HIV-related services among female sex workers in Zimbabwe
There remains a significant information gap with respect to HIV epidemiology and intervention uptake among high-risk, marginalised populations such as female sex workers (FSW) in sub-Saharan Africa because of the complexities of surveillance among these groups. Data from outreach programmes are a valuable but neglected resource.
Analysis of data from FSW consultations with Zimbabwe’s National Sex Work programme at 26 sites in all provinces of Zimbabwe, 2009-14. Data were collected on socio-demographic characteristics, HIV testing history, HIV tests conducted by the programme and antiretroviral (ARV) history. Characteristics at first visit to the programme were described. Longitudinal data on programme engagement, repeat HIV testing and HIV sero-conversion were analysed.
Data was available on 13360 women, 31389 programme visits, 14579 reported HIV tests, 2750 tests undertaken by the programme and 2387 reported ARV treatment initiations. At first visit, 72% of FSW had tested for HIV; 50% of these reported being HIV-positive. Among HIV-positive women, 41% reported being on ARV. 56% of FSW attended the programme only once. HIV-negative FSWs were aware of their negative status 26% of the time. After testing HIV-positive, women started on ARV at a rate of 23 women per 100 person years of follow-up. Among those with two or more HIV tests, the HIV sero-conversion rate was 10 / 100 person years of follow-up.