HIV treatment cascade among female entertainment and sex workers in Cambodia: impact of amphetamine use and an HIV prevention program

Abstract

Background: HIV prevalence remains high in Cambodia among female entertainment and sex workers (FESW), and amphetamine-type stimulant (ATS) use significantly increases risk of infection. A successful continuum of care (CoC) is key to effective clinical care and prevention. This study aimed to describe the HIV CoC in HIV-positive FESW. We examined CoC outcomes among HIV-positive FESW participating in the Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study, being implemented in ten provinces. CIPI is a trial aimed at reducing ATS use concomitant with the SMARTgirl HIV prevention program. Methods:From 2013 to 2016, 1198 FESW ≥ 18 years old who reported multiple sex partners and/or transactional sex were recruited. We identified 88 HIV-positive women at baseline. We described linkage to care as 12-month retention and viral suppression (<1000 copies/mL). Logistic regression analyses were conducted to examine correlates of retention in care at 12 months, and viral suppression.Results: Median age of the 88 HIV-positive women was 32 years [interquartile range (IQR) 28, 35]; 50% were working in entertainment venues and 50% as freelance sex workers; 70% reported SMARTgirl membership. In the past 3 months, women reported a median of 15 sex partners, 38% reported unprotected sex, and 55% reported using ATS. Overall, 88% were receiving HIV care, 83% were on antiretroviral therapy, 39% were retained in care at 12 months, and 23% were virally suppressed. SMARTgirl membership was independently associated with fourfold greater odds of 12-month retention in care (AOR = 4.16, 95% CI 1.38, 12.56). Those at high risk for an ATS use disorder had 91% lower odds of 12-month retention in care (AOR = 0.09, 95% CI 0.01, 0.72). Viral suppression was independently associated with SMARTgirl membership, older age, reporting of STI symptoms, worse symptoms of psychological distress, and greater numbers of sex partners. Conclusions: This is the first study to characterize the HIV CoC in Cambodian FESW. While most women were successfully linked to HIV care, retention and viral suppression were low. Tailored programs like SMARTgirl, targeting the broader population of HIV-positive FESW as well as interventions to reduce ATS use could optimize the clinical and population health benefits of HIV treatment.

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

“…Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak (S3 Text). Sixteen studies (14 moderate; 2 weak) selected participants based on harmful alcohol or drug use (n = 9) [24,26,31,33,34,[37][38][39][40], or positive [32,41] or negative [29,[42][43][44][45] HIV status (n = 5), and were excluded from the meta-analyses (regardless of CEBM score) to avoid biasing the pooled estimates. Analyses used a variety of validated scales and cut-off points to assess mental disorders (Table 1).…”

Cascade of care for people living with HIV infection in Southern Brazil: results from a public health network

“…Some studies represent these two approaches together, probably because they provide better information about the healthcare process, especially for viral load Cad. Saúde Pública 2018; 34(12):e00009718 suppression 27,28 . For example, in a study with HIV-positive sex workers in Cambodia, viral suppression was obtained only for 23% of the diagnosed HIV-positive women in the cohort, but this proportion increased to 59% when considering female patients that were in care for the last 12 months 28 .…”

“…Saúde Pública 2018; 34(12):e00009718 suppression 27,28 . For example, in a study with HIV-positive sex workers in Cambodia, viral suppression was obtained only for 23% of the diagnosed HIV-positive women in the cohort, but this proportion increased to 59% when considering female patients that were in care for the last 12 months 28 . In India, 31% of the diagnosed patients and 82% of patients who used cART achieved viral suppression 29 .…”

Substance use and the HIV care continuum: important advances

“…In Pretoria, South Africa, women who reported recent physical assault were more likely to be newly diagnosed with HIV, and those using opiates or cocaine were less likely to receive antiretroviral therapy [ 7 ]. Similarly, female entertainment and sex workers in Thailand who used methamphetamines were less likely to be retained in care at 12 months [ 8 ].…”