title: Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.
abstract: BACKGROUND
  Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala.
  
  
  METHODS
  Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.
  
  
  RESULTS
  During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.
  
  
  CONCLUSIONS
  Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Sonia
authors.initials: S
authors.lastname: Morales-Miranda
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Jerry O
authors.initials: JO
authors.lastname: Jacobson
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Itzel
authors.initials: I
authors.lastname: Loya-Montiel
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mendizabal-Burastero
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: César
authors.initials: C
authors.lastname: Galindo-Arandi
authors.affiliation: National STI/HIV/AIDS Program, Ministry of Public Health, Guatemala City, Guatemala.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention - Central America Regional Office, Guatemala City, Guatemala.
authors.forename: Sanny Y
authors.initials: SY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D055815:Young Adult