Health‐related quality of life of female sex workers living with HIV in South Africa: a cross‐sectional study

Abstract

Introduction:Health-related quality of life (HRQoL) is an important HIV outcome beyond viral suppression. However, there are limited data characterizing HRQoL of key populations, including female sex workers (FSW) living with HIV. Methods: We used baseline data (22 June 2018-23 March 2020) of FSW who were diagnosed with HIV and enrolled into a randomized trial in Durban, South Africa. HRQoL information was collected by a generic preference-accompanied tool with five domains (EQ-5D), and summarized into a single score (range 0-1), which represents health utility. We employed multivariable beta regression models to identify determinants of HRQoL and to estimate subgroup-specific HRQoL score. Using external estimates of life expectancy and population size, we estimated the number of quality adjusted life years reduced among FSW living with HIV in South Africa associated with violence and drug use. Results: Of 1,363 individuals (mean age: 32.4 years; mean HRQoL score: 0.857) in our analysis, 62.6% used drugs, 61.3% experienced physical or sexual violence and 64.6% self-reported taking antiretroviral treatment (ART). The following were associated with a reduction in the average marginal HRQoL score: older age (per decade: 0.018 [95% confidence interval (CI): 0.008, 0.027]), drug use (0.022 [0.007, 0.036]), experience of violence (0.024 [0.010, 0.038]) and moderate (vs. no) level of internalized stigma (0.023 [0.004, 0.041]). Current ART use was associated with a 0.015-point (-0.001, 0.031) increase in the HRQoL score. The estimated mean (95% CI) HRQoL scores ranged from 0.838 (0.816, 0.860) for FSW who used drugs, experienced violence and were not on ART; to 0.899 (0.883, 0.916) for FSW who did not use drugs nor experience violence and were on ART. Our results can be translated into a reduction in 37,184 and 39,722 quality adjusted life years related to drug use and experience of violence, respectively, in South Africa. Conclusions: These results demonstrate the association of ART with higher HRQoL among FSW and the need to further address structural risks, including drug use, violence and stigma. Population-specific estimates of HRQoL score can be further used to calculate quality-adjusted life years in economic evaluations of individual and structural interventions addressing the needs of FSW living with HIV.

ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study

“…Interventions supporting stable housing may have multifaceted impacts for HIV treatment access, storage, and daily adherence, ultimately leading to optimal health outcomes and viral suppression. Finally, a complementary analysis among FSW at enrollment into Siyaphambili also reinforced the importance of structural determinants, finding that drug use, violence, stigma, and lack of ART use all contributed to lower health-related quality of life scores [ 71 ]. Taken together these multilevel determinants iteratively shape HIV transmission dynamics and heterogeneously impact FSW living with HIV, disproportionally affecting women at increased vulnerability [ 25 , 26 ].…”

HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study

“…The model using overall QoL showed that enacted sex work stigma, internalized sex work stigma and enacted HIV stigma were associated with a decrease in prevalence of high overall QoL. Another analysis using the same study population similarly linked internalized stigma with overall QoL using the EuroQoL five dimension, three-level questionnaire (EQ-5D-3L) [ 63 ]. This previous analysis also reported that increased internalized and experienced stigma were associated with a lower EuroQoL visual analogue scale (EQ-VAS).…”

Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis

“…Siyaphambili study procedures, including recruitment and sampling methods, are reported in detail elsewhere. [19][20][21] Briefly, peers conducted study recruitment activities from a mobile van in mapped priority sex work venues in eThekwini Municipality (Durban) and from a drop-in center managed by TB HIV Care, the largest key populationsfocused HIV service provider within the district. Across community and clinical settings, peers approached potentially eligible women and invited them to screen for study enrollment.…”