Background: To increase linkages to and retention in ART care, we designed and piloted the delivery of community-based ART services to FSWs using community-based HIV testing and counseling platforms (mobile and home-based). This abstract presents impact of the intervention on ART linkage, retention, and viral suppression.
Methods: The study used a quasi-experimental design. Eligible participants were women who sold sex for money or goods in the past 6 months, aged 18+, HIV-positive, and not currently on ART.
A cohort of 617 eligible FSWs were recruited in July-October 2017. FSWs in the intervention group (n=309/Njombe Region) were enrolled into community-based ART and immediately received one month of ARVs. At refills, each FSW received 3 months of ARVs. FSWs in the comparison group (n=308/Mbeya Region) were referred to public ART facilities (at government facility, fixed refill date, one month of ARVs). At 12 months post-enrollment, we re-interviewed 527 FSWs of the original cohort (Njombe=265; Mbeya=262). Key outcomes were ART initiation, retention, and viral suppression (viral load of ≤1000/ml). We used chi-square tests and multiple logistic regression to compare 12-month ART outcomes between intervention and control groups.
Results: Median participant age was 30 years; half were never married; a third were divorced. One-third learned their HIV-positive status for the first time at study enrollment. Lost-to-follow-up participants (15%) were comparable across the groups.
FSWs in the intervention were more likely to have initiated ART (100% versus 79%; p< 0.001). Among ART-initiated patients, retention was 99% in the intervention and 96% in the comparison (p=0.05). Among patients on ART, viral suppression was 84% in both groups (non-significant). FSWs in the intervention reported higher level of satisfaction regarding their last visit (99.0% versus 80%;p< 0.001). ART initiation and client satisfaction outcomes remained statistically significant in multiple logistic regression.
Conclusions: Community-based ART distribution can improve ART linkage and initiation among FSWs. Findings suggest that the most critical part in reaching 90% retention and viral suppression is linking and immediately initiating patients on ART. Once on ART, viral suppression was high regardless of service modality. The national HIV response must seek to expand this community-based model to close the ART initiation gap.