title: High Drop-off Along the HIV Care Continuum and ART Interruption Among Female Sex Workers in the Dominican Republic.
abstract: BACKGROUND
  Engagement in HIV care offers clear individual and societal benefits, but little evidence exists on the care experiences of key populations.
  
  
  METHODS
  A cross-sectional survey was conducted with 268 female sex workers (FSWs) living with HIV in Santo Domingo, Dominican Republic, to describe the HIV care continuum and to determine factors associated with antiretroviral therapy (ART) interruption.
  
  
  RESULTS
  FSWs disengaged throughout the care continuum with the highest drop-off after ART initiation. Most participants were linked to care (92%), retained in care (85%), and initiated onto ART (78%), but ART discontinuation and irregular adherence were frequent. Only 48% of participants had an undetectable HIV viral load. Overall, 36% of participants ever initiated onto ART reported lifetime experience with ART interruption. The odds of ART interruption were 3.24 times higher among women who experienced FSW-related discrimination [95% confidence interval (CI): 1.28 to 8.20], 2.41 times higher among women who used any drug (95% CI: 1.09 to 5.34), and 2.35 times higher among women who worked in an FSW establishment (95% CI: 1.20 to 4.60). Internalized stigma related to FSW was associated with higher odds of interruption (adjusted odds ratio: 1.09; 95% CI: 1.02 to 1.16), and positive perceptions of HIV providers were protective (adjusted odds ratio: 0.91; 95% CI: 0.85 to 0.98).
  
  
  CONCLUSIONS
  FSWs living with HIV confront multiple barriers throughout the HIV care continuum, many of which are related to the social context and stigmatization of sex work. Given the clear importance of maximizing the potential benefits of engagement in HIV care, there is an urgent need for interventions to support FSWs throughout the HIV care continuum.
authors.affiliation: *Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health; †Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; and ‡Unidad de Vacunas, Instituto Dermatologico y Cirugía de Piel (IDCP)/Centro de Orientación e Investigación Integral (COIN)/Dirección Nacional de Control de Infecciones de Transmisión Sexual y SIDA (DIGECITSS), Santo Domingo, Dominican Republic.
authors.forename: Rose
authors.initials: R
authors.lastname: Zulliger
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.forename: Yeycy
authors.initials: Y
authors.lastname: Donastorg
authors.forename: Martha
authors.initials: M
authors.lastname: Perez
authors.forename: Deanna
authors.initials: D
authors.lastname: Kerrigan
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D004293:Dominican Republic; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D010349:Patient Compliance; D060386:Sex Workers
chemical_list: D044966:Anti-Retroviral Agents