title: The HIV Care Cascade Among Female Sex Workers in Zimbabwe: Results of a Population-Based Survey From the Sisters Antiretroviral Therapy Programme for Prevention of HIV, an Integrated Response (SAPPH-IRe) Trial.
abstract: Female sex workers (FSW) in sub-Saharan Africa have a higher prevalence of HIV than other women of reproductive age. Social, legal, and structural barriers influence their access to care. Little is known about the HIV diagnosis and care cascade in most countries in Southern Africa. We aimed to describe the HIV diagnosis and care cascade among FSW in Zimbabwe.
  
  
  
  We conducted cross-sectional respondent driven sampling (RDS) surveys of FSW in 14 sites across Zimbabwe as the baseline for a cluster-randomised controlled trial investigating a combination HIV prevention and care package. We administered a questionnaire, tested women for HIV and measured viral load. We report the mean, minimum, and maximum respondent-driven sampling-2 weighted site values.
  
  
  
  The survey included 2722 women, approximately 200 per site. The mean HIV prevalence was 57.5% (42.8-79.2 site minimum and maximum). Of HIV-positive women, 64.0% (51.6-73.7) were aware of their status, 67.7% (53.4-84.1) of these reported taking antiretroviral therapy, and 77.8% (64.4-90.8) of these had a suppressed HIV viral load (<1000 copies/mL). Among all HIV-positive women, 49.5% had a viral load < 1000 copies/mL.
  
  
  
  Although most HIV-positive women aware of their status are accessing antiretroviral therapy, 36.0% of HIV-positive women are unaware of their status and 29.3% of all FSW have an unsuppressed HIV viral load. Investigation and investment into models of testing, treatment, and care are necessary to reach UNAIDS targets for HIV elimination.
authors.affiliation: *Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; †Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe; ‡Department of Social and Environmental Health Research, Centre for Evaluation, Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; §Women's Global Health Imperative, RTI International, San Francisco, CA; ‖United Nations Population Fund, Harare, Zimbabwe; ¶Gesellschaft für Internationale Zusammenarbeit, Harare, Zimbabwe; #Midlands Province, Ministry of Health and Child Welfare, Harare, Zimbabwe; **Matebeleland North Province, Ministry of Health and Child Welfare, Harare, Zimbabwe; ††Population Services International Global, Harare, Zimbabwe; ‡‡HIV AIDS TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe; and §§Department of Population Studies, Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Calum B
authors.initials: CB
authors.lastname: Davey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fearon
authors.forename: Phillis
authors.initials: P
authors.lastname: Mushati
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dirawo
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.forename: Sue
authors.initials: S
authors.lastname: Napierala Mavedzenge
authors.forename: Dagmar
authors.initials: D
authors.lastname: Hanisch
authors.forename: Ramona
authors.initials: R
authors.lastname: Wong-Gruenwald
authors.forename: Milton
authors.initials: M
authors.lastname: Chemhuru
authors.forename: Nyasha
authors.initials: N
authors.lastname: Masuka
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Joanna
authors.initials: J
authors.lastname: Busza
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Philips
authors.forename: James R
authors.initials: JR
authors.lastname: Hargreaves
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D015995:Prevalence; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D018401:Sample Size; D060386:Sex Workers; D011795:Surveys and Questionnaires; D019562:Viral Load; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents