title: HIV prevention and care services for female sex workers: efficacy of a targeted community-based intervention in Burkina Faso.
abstract: BACKGROUND
  Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso.
  
  
  METHODS
  Between September 2009 and September 2011 we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months. The intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. We compared the cohort HIV incidence with a modelled expected incidence in the study population in the absence of intervention, using data collected at the same time from FSW clients.
  
  
  RESULTS
  The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01-5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients (adjusted odds ratio (aOR)=2.19; 95% CI, 1.16-4.14, p=0.01) and with regular clients (aOR=2.18; 95% CI, 1.26-3.76, p=0.005).
  
  
  CONCLUSIONS
  Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.
authors.affiliation: Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa; tiandiogo2002@yahoo.fr.
authors.forename: Isidore T
authors.initials: IT
authors.lastname: Traore
authors.affiliation: Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa.|Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
authors.forename: Noelie M
authors.initials: NM
authors.lastname: Hema
authors.affiliation: Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
authors.forename: Djeneba
authors.initials: D
authors.lastname: Ouedraogo
authors.affiliation: Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
authors.forename: Felicien
authors.initials: F
authors.lastname: Some
authors.affiliation: Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
authors.forename: Roselyne
authors.initials: R
authors.lastname: Some
authors.affiliation: Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
authors.forename: Josiane
authors.initials: J
authors.lastname: Niessougou
authors.affiliation: Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa.
authors.forename: Anselme
authors.initials: A
authors.lastname: Sanon
authors.affiliation: Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa.
authors.forename: Issouf
authors.initials: I
authors.lastname: Konate
authors.affiliation: UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France.|CHRU Montpellier, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Van De Perre
authors.affiliation: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
authors.affiliation: UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France.|CHRU Montpellier, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Africa; HIV; female sex workers; incidence