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Clinical Trial
. 2017 Jan 1;74 Suppl 1(Suppl 1):S60-S68.
doi: 10.1097/QAI.0000000000001203.

Project Shikamana: Baseline Findings From a Community Empowerment-Based Combination HIV Prevention Trial Among Female Sex Workers in Iringa, Tanzania

Deanna Kerrigan  1 , Jessie Mbwambo, Samuel Likindikoki, Sarah Beckham, Ard Mwampashi, Catherine Shembilu, Andrea Mantsios, Anna Leddy, Wendy Davis, Noya Galai
Affiliations
Clinical Trial

Project Shikamana: Baseline Findings From a Community Empowerment-Based Combination HIV Prevention Trial Among Female Sex Workers in Iringa, Tanzania

Deanna Kerrigan et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Community empowerment approaches have been found to be effective in responding to HIV among female sex workers (FSWs) in South Asia and Latin America. To date, limited rigorous evaluations of these approaches have been conducted in sub-Saharan Africa.

Methods: A phase II community randomized controlled trial is being conducted in Iringa, Tanzania, to evaluate the effectiveness of a community empowerment-based combination HIV prevention model (Project Shikamana) among a stratified sample of HIV-infected and HIV-uninfected FSWs. Cohort members were recruited from entertainment venues across 2 communities in the region using time-location sampling. All study participants gave consent, and were surveyed and screened for HIV at baseline. Primary biological study outcomes are viral suppression among the HIV-infected and remaining free of HIV among HIV-uninfected women.

Results: A cohort of 496 FSWs was established and is currently under follow-up. Baseline HIV prevalence was 40.9% (203/496). Among HIV-infected FSWs, 30.5% (62/203) were previously aware of their HIV status; among those who were aware, 69.4% were on antiretroviral therapy (43/62); and for those on antiretroviral therapy, 69.8% (30/43) were virally suppressed. Factors associated with both HIV infection and viral suppression at baseline included community, age, number of clients, and substance use. Amount of money charged per client and having tested for sexually transmitted infection in the past 6 months were protective for HIV infection. Social cohesion among FSWs was protective for viral suppression.

Conclusions: Significant gaps exist in HIV service coverage and progress toward reaching the 90-90-90 goals among FSWs in Iringa, Tanzania. Community empowerment approaches hold promise given the high HIV prevalence, limited services and stigma, discrimination, and violence.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Comparison with the “90-90-90” targets among the Shikamana cohort at baseline. Definitions: known HIV status out of those testing positive; currently receiving ART among those aware of positive status; and VL <400 copies per milliliter among those currently on ART.
See this image and copyright information in PMC

References

    1. Kerrigan D, Kennedy C, Morgan T, et al. Female, male and transgender sex workers, epidemiology of HIV/AIDS. Encylopedia of AIDS 2015:1–8.
    1. Kerrigan D, Wirtz A, Baral S, et al. The Global HIV Epidemics Among Sex Workers. Washington, DC: World Bank; 2013.
    1. Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:538–549. - PubMed
    1. Tanzania National AIDS Control Program, PSI Tanzania. HIV Biological and Behavioral Surveys: Tanzania 2013. Female Sex Workers in Seven Regions. Dar es Salaam, Iringa, Mbeya, Mwanza, Tabora, Shinyanga and Mara: United Republic of Tanzania, Ministry of Health and Social Welfare, National AIDS Control Programme; 2013.
    1. Beckham S, Kennedy C, Brahmbhatt H, et al. Strategic Assessment to Define a Comprehensive Response to HIV in Iringa, Tanzania. Research Brief. Baltimore, MD: Female Sex Workers; USAID Project Search; Research to Prevention: 2013. Available at: http://www.jhsph.edu/research/centers-and-institutes/research-to-prevent.... Accessed January 10, 2014.

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