Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy

Ingabire, Rosine; Parker, Rachel; Nyombayire, Julien; Ko, Jasmine E.; Mukamuyango, Jeannine; Bizimana, Jean de Dieu; Price, Matt A.; Laufer, Dagna; Tichacek, Amanda; Wall, Kristin M.; Allen, Susan; Karita, Etienne

doi:10.1177/0956462418817050

Cited by 26 publications

(27 citation statements)

References 55 publications

(57 reference statements)

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“…Our finding that nearly all FSW (95%) reported ever testing for HIV test is higher than the proportion (55%) previously reported in this setting [6], but consistent with findings from Kenya, Benin and Rwanda, where 86.6%, 87.1% and 90.0% of FSW, respectively, reported ever testing for HIV [28,34,35]. The higher testing rates we found could be due to targeted HIV testing programs for FSW in Uganda which aim to achieve the national strategic plan target of at least 90% testing coverage among persons with HIV in order to achieve HIV epidemic control by 2030 [19,36].…”

Section: Discussionsupporting

confidence: 90%

Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

Muhindo¹,

Castelnuovo²,

Mujugira³

et al. 2020

Preprint

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Background: Few studies have evaluated intentions to undergo periodic sexually transmitted infection (STI) and HIV testing among female sex workers (FSW) in Sub-Saharan Africa. We aimed to assess intention to seek periodic syphilis and HIV testing among FSW in Uganda. Methods: Between July and October 2018, we conducted a cross-sectional study among 441 FSW. Participants were recruited through peer referrals. Self-reported data on intention to take a syphilis test in the next 3 months and an HIV test in next 6 months were obtained using an interviewer-administered questionnaire. We used constructs of the Integrated Change Model to assess intentions, attitudes, norms, social influences and self-efficacy towards 3-monthly syphilis and 6-monthly HIV testing. Predictors of intention to seek testing were estimated using linear regression.Results: A total of 441 FSW were included in the analysis, and the median age was 26 years (interquartile range [IQR] 23–30). Most (66.9%) reported high intention to take an HIV test in the next 6 months, and 51.9% showed high intention to take a serological syphilis test in the next 3 months. In multivariable analysis, never testing for HIV was associated with low intention of testing (β=-0.15, p=0.001). Factors significantly associated with high intentions to test for HIV in the next 6 months were perceived influence of significant others (β=0.08, p=0.03), high self-efficacy (β=0.26, p=0.001) and high attitude scores (β=0.45, p=0.001). Similarly, high attitude (β=0.30, P=0.001) and descriptive norms (β=0.32, P=0.001) were associated with high intentions to test for syphilis in the next three months. Conclusion: These results suggest public health programs promoting routine HIV and syphilis testing should consider factors such as attitudes, descriptive norms, social influences, self-efficacy and past behaviours which inform intention to undergo STI testing.

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Section: Discussionsupporting

confidence: 90%

Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

Muhindo¹,

Castelnuovo²,

Mujugira³

et al. 2020

Preprint

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“…The design of this study was informed by findings of formative, qualitative research conducted with patients at study health centres, 15 clinical experiences of several of the authors, along with input from public health and clinical leaders in Rwanda. The research questions and design were reviewed by investigators with expertise in HIV health service delivery and infectious diseases, along with input from an advisory committee consisting of leadership from study health centres as well as the Rwanda Biomedical Centre, the nation’s central health implementation agency.…”

Section: Discussionmentioning

confidence: 99%

“…Our earlier research in Rwanda identified frequent appointments as burdensome to newly diagnosed PLHIV because of structural issues such as transportation cost and long wait times, as well as stigma experienced while travelling to and while at the health centre. 15 Modifying the definition of clinically stable adults living with HIV to decrease the time on ART and reduce the number of viral load measurements could potentially reduce the burden faced by patients and health systems. However, implementing DSD earlier in patients’ treatment may not provide them with the support needed to become stable in care and achieve viral suppression.…”

Section: Introductionmentioning

confidence: 99%

Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

et al. 2021

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IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

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“…It was not defined explicitly and held unstable meaning, even within the same document. These ambiguities have proven persistent [5‐10] (See Appendix ).…”

Section: Discussionmentioning

confidence: 99%

From general to specific: moving past the general population in the HIV response across sub‐Saharan Africa

Makofane

Elst

Walimbwa³

et al. 2020

J. Intern. AIDS Soc.

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Introduction: As the HIV field evolves to better serve populations which are diverse in risk and access to services, it is crucial to understand and adapt the conceptual tools used to make sense of the HIV pandemic. In this commentary, we discuss the concept of general population. Using a synthetic and historical review, we reflect on the genesis and usage of the general population in HIV research and programme literature, pointing to its moral connotations and its impact on epidemiologic reasoning. Discussion: From the early days of the HIV pandemic, the category of general population has carried implicit normative meanings. General population represented those people considered to be undeserving of HIV acquisition, and therefore deserving of a response. Framing the HIV epidemic in sub-Saharan Africa as a generalized epidemic primarily affecting the general population has contributed to the exclusion of men who have sex with men from epidemic responses. The usage of this category has also masked heterogeneity among those it includes; the increasing focus on the use of interventions such as circumcision and HIV treatment as general population HIV prevention approaches has been marked by a lack of attention to heterogeneity among beneficiaries. Conclusions: We recommend that the term general population be retired from the field's lexicon. HIV programmes should strengthen their capacity to describe the heterogeneity of those they serve and plan their interventions accordingly. To increase the efficiency and impact of the HIV response, it is urgent to stratify the category of general population by risk. Sexual networks are a promising basis for this stratification.

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Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy

Cited by 26 publications

References 55 publications

Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

From general to specific: moving past the general population in the HIV response across sub‐Saharan Africa

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