Retention and risk factors for loss to follow-up of female and male sex workers on antiretroviral treatment in Ivory Coast: a retrospective cohort analysis.
BACKGROUND
Antiretroviral therapy (ART) for HIV-infected sex workers is an important HIV prevention strategy. However, sex workers may have additional challenges for retention in ART care. The objectives of this study were to assess retention of sex workers on ART in a routine setting in Ivory Coast and identify risk factors for loss to follow-up (LTFU).


METHODS
The design was a retrospective cohort study. An analysis of clinic files was conducted in 2 sites providing ART services to sex workers in Ivory Coast. Demographic, behavior, and clinical data of female and male sex workers on ART were abstracted onto a standardized anonymous data collection form. Data collection took place between May 11 and 28, 2010.


RESULTS
A total of 376 female and 38 male sex workers were included in the analysis. The retention probability was 75% at 6 months, 68% at 12 months, 55% at 24 months, and 47% at 36 months. Attrition was mainly because of LTFU. Factors significantly associated with LTFU in bivariate analysis were lower schooling level, later calendar year of starting ART, and not receiving initial adherence counseling. Later year of starting ART and not receiving adherence counseling at ART initiation remained significantly associated with LTFU in a multivariate Cox regression model.


CONCLUSIONS
To improve the retention of sex workers on ART, there is a need for more in-depth investigation of the role of pre-ART counseling and the increasing rates of LTFU with each calendar year.
*Institute of Tropical Medicine, Antwerp, Belgium; †Family Health International 360, Abidjan, Ivory Coast; ‡Centers for Disease Control and Prevention, Atlanta, GA; §Elisabeth Glazer Paediatric AIDS Foundation, Abidjan, Ivory Coast.
Bea
B
Vuylsteke
Gisèle
G
Semdé
Andrew F
AF
Auld
Jennifer
J
Sabatier
Joseph
J
Kouakou
Virginie
V
Ettiègne-Traoré
Anne
A
Buvé
Marie
M
Laga
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D007560:Cote d'Ivoire; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D055815:Young Adult
D019380:Anti-HIV Agents