Peer Recruitment Strategies for Female Sex Workers Not Engaged in HIV Prevention and Treatment Services in Côte d’Ivoire: Program Data Analysis (Preprint)

Abstract

BACKGROUND In the context of the mostly generalized HIV epidemic in Cote d’Ivoire, key populations (KPs), including female sex workers (FSWs) and men who have sex with men (MSM), bear a higher burden of HIV than other reproductive aged adults. Mathematical models have demonstrated the significant potential impact and cost-effectiveness of improving the coverage of HIV prevention and treatment services for key populations in Cote d’Ivoire. However, in 2019, coverage of these services remains limited by multiple intersecting stigmas affecting key populations, necessitating the study of innovative implementation strategies to better meet the needs of those most marginalized. Here, we leverage programmatic data to compare the effectiveness of the enhanced peer outreach approach (EPOA) and traditional peer outreach approaches in reaching and providing community HIV testing to FSWs not currently engaged in HIV prevention and treatment services in Cote d’Ivoire. OBJECTIVE The aim of this study was to describe the characteristics of FSWs reached by the LINKAGES project in Cote d’Ivoire with EPOA and traditional peer outreach and compare HIV-related outcomes between women reached by both strategies. METHODS De-identified routine programmatic data collected as part of LINKAGES Cote d’Ivoire between October 2017 and April 2018 were used in these analyses. Demographic characteristics and HIV indicators including HIV testing history, HIV case finding, linkage to HIV treatment and treatment initiation were assessed using descriptive statistics. Differences in these indicators by outreach strategy were then compared using Pearson’s Chi-squared tests. RESULTS The overall HIV prevalence of the 18,889 FSWs included in this study was 9.7%. Outcome comparison by outreach approach was carried out for 9,761 of 18,889 women reached and program participants reached by EPOA represented 26% of the analytical sample. Compared with women reached by the routine outreach approach, those reached by EPOA were more likely to have ever been previously tested for HIV (68% vs 60%; p < 0.001). EPOA was associated with a higher HIV case finding rate (11% vs 7%; p < 0.001) and women who were reached by EPOA were more likely to be linked to treatment (p <0.001) and initiated on treatment (p > 0.05). Women reached by both approaches were categorized as high risk for HIV-related behaviors such as condomless sex and number of sex acts in the previous week. CONCLUSIONS These analyses suggest that a novel peer-referral strategy, EPOA, was effective in reaching FSWs in Cote d’Ivoire who were at high risk for HIV and not reached by routine outreach approach. Scaling up novel outreach strategies like EPOA with differentiated service models may be needed to optimize HIV prevention and treatment outcomes for key populations in Cote d’Ivoire.