title: The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi.
abstract: OBJECTIVE
  The HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi.
  
  
  METHODS
  From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome.
  
  
  RESULTS
  HIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22-28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3-17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes.
  
  
  CONCLUSIONS
  FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.|Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Kathryn Elizabeth
authors.initials: KE
authors.lastname: Lancaster
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.
authors.forename: Thandie
authors.initials: T
authors.lastname: Lungu
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.
authors.forename: Pearson
authors.initials: P
authors.lastname: Mmodzi
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.|Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Theatre for a Change, Lilongwe, Malawi.
authors.forename: Katy
authors.initials: K
authors.lastname: Chadwick
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Vivian F
authors.initials: VF
authors.lastname: Go
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.|Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.|Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008295:Malawi; D011477:Sex Work; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents