Using a Programme Science approach to substantially reduce the risk of HIV transmission and acquisition in sex transactions among female sex workers in Zimbabwe.
Africa
HIV care
HIV prevention
Programme Science
programme implementation
sex workers
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
Jul 2024
Jul 2024
Historique:
received:
12
10
2023
accepted:
19
04
2024
medline:
11
7
2024
pubmed:
11
7
2024
entrez:
11
7
2024
Statut:
ppublish
Résumé
We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%-1.8%) of the population of women aged 15-49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019-30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016-30 September 2022) Reorientating implementation of DREAMS for young women selling sex). Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required. Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention. Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or implement differently.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26262Informations de copyright
© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
Références
Garnett GP. Reductions in HIV incidence are likely to increase the importance of key population programmes for HIV control in sub‐Saharan Africa. J Int AIDS Soc. 2021;24 Suppl 3(Suppl 3):e25727.
Makofane K, van der Elst EM, Walimbwa J, Nemande S, Baral SD. From general to specific: moving past the general population in the HIV response across sub‐Saharan Africa. J Int AIDS Soc. 2020;23 Suppl 6(Suppl 6):e25605.
Chersich MF, Luchters S, Ntaganira I, Gerbase A, Lo YR, Steen R. Priority interventions to reduce HIV transmission in sex work settings in sub‐Saharan Africa and delivery of these services. J Int AIDS Soc. 2013;16:17890.
HIV/AIDS UNGASSo. Declaration on HIV and AIDS. 2001. http://www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html2001
O'Farrell N. Genital ulcers, stigma, HIV, and STI control in sub‐Saharan Africa. Sex Transm Infect. 2002;78(2):143–146.
Hanenberg RS, Rojanapithayakorn W, Kunasol P, Sokal D. Impact of Thailand's HIV control programme as indicated by the decline of sexually transmitted diseases. Lancet. 1994;344:243–245.
Celentano D, Bond K, Lyles C, Eiumtrakul S, Go V, Beyrer C, et al. Preventive intervention to reduce sexually transmitted infections: a field trial in the Royal Thai Army. Arch Intern Med. 2000;160:535–540.
Rojanapithayakorn W, Hanenberg RS. The 100% Condom Program in Thailand. AIDS. 2002;10:1–7.
Ng M, Gakidou E, Levin‐Rector A, Khera A, Murray CJ, Dandona L. Assessment of population‐level effect of Avahan, an HIV‐prevention initiative in India. Lancet. 2011;378(9803):1643–1652.
Vassall A, Pickles M, Chandrashekar S, Boily M‐C, Shetty G, Guinness L, et al. Cost‐effectiveness of HIV prevention for high‐risk groups at scale: an economic evaluation of the Avahan programme in south India. Lancet Glob Health. 2014;2(9):e531–e540.
Pickles M, Boily MC, Vickerman P, Lowndes CM, Moses S, Blanchard JF, et al. Assessment of the population‐level effectiveness of the Avahan HIV‐prevention programme in South India: a preplanned, causal‐pathway‐based modelling analysis. Lancet Glob Health. 2013;1(5):e289–e299.
Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Prevention of HIV‐1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. https://doi.org/10.1056/NEJMoa1105243
Boily MC, Pickles M, Alary M, Baral S, Blanchard J, Moses S, et al. What really is a concentrated HIV epidemic and what does it mean for West and Central Africa? Insights from mathematical modeling. J Acquir Immune Defic Syndr. 2015;68(Suppl 2):S74–S82.
Steen R, Hontelez JA, Veraart A, White RG, de Vlas SJ. Looking upstream to prevent HIV transmission: can interventions with sex workers alter the course of HIV epidemics in Africa as they did in Asia? AIDS. 2014;28:891–899.
Pruden HWC, Vickerman P, Bobrova N, Heise L, Ogungbemi M, Bomah A, et al. Can the UNAIDS modes of transmission model be improved?: a comparison of the original and revised model projections using data from a setting in west Africa. AIDS. 2013;27:2623–2635.
Beattie TSH, Mohan HL, Bhattacharjee P, Chandrashekar S, Isac S, Wheeler T, et al. Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk. Am J Public Health. 2014;104(8):1516–1525.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV‐1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–2599.
Becker M, Mishra S, Aral S, Bhattacharjee P, Lorway R, Green K, et al. The contributions and future direction of Program Science in HIV/STI prevention. Emerg Themes Epidemiol. 2018;15:7.
Blanchard JF, Bhattacharjee P, Kumaran S, Ramesh BM, Kumar NS, Washington RG, et al. Concepts and strategies for scaling up focused prevention for sex workers in India. Sex Transm Infect. 2008;84(Suppl 2):ii19–ii23.
Blanchard A, Mohan HL, Shahmanesh M, Prakash R, Isac S, Ramesh BM, et al. Community mobilization, empowerment and HIV prevention among female sex workers in south India. BMC Public Health. 2013;13(1):234.
Cowan FM, Machingura F, Chabata ST, Ali MS, Busza J, Steen R, et al. Differentiated prevention and care to reduce the risk of HIV acquisition and transmission among female sex workers in Zimbabwe: study protocol for the ‘AMETHIST’ cluster randomised trial. Trials. 2022;23(1):209.
Cowan FM, Machingura F, Ali S, Chabata ST, Takura A, Bansi‐Matharu L, et al. Cluster randomised trial of risk‐differentiated care for female sex workers: AMETHIST. 25th Conference on Retroviruses and Opportunistic Infections; Seattle, WA; 2023.
PEPFAR. DREAMS Core Package of Interventions Summary. Washington, DC: PEPFAR; 2016.
Busza J. Underage and underserved: reaching young women who sell sex in Zimbabwe. AIDS Care. 2015:14–20.
Cowan FM, Chabata ST, Musemburi S, Fearon E, Davey C, Ndori‐Mharadze T, et al. Strengthening the scale‐up and uptake of effective interventions for sex workers for population impact in Zimbabwe. J Int AIDS Soc. 2019;22(Suppl 4):e25320.
Fearon E, Chabata ST, Magutshwa S, Ndori‐Mharadze T, Musemburi S, Chidawanyika H, et al. Estimating the population size of female sex workers in Zimbabwe: comparison of estimates obtained using different methods in twenty sites and development of a national‐level estimate. J Acquir Immune Defic Syndr. 2020;85(1):30–38.
Chabata ST, Hensen B, Chiyaka T, Mushati P, Musemburi S, Dirawo J, et al. The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non‐randomised study. BMJ Glob Health. 2021;6(4):e003892.
Hensen B, Hargreaves JR, Chiyaka T, Chabata S, Mushati P, Floyd S, et al. Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non‐randomised study in Zimbabwe. BMC Public Health. 2018;18:203.
Machingura F, Busza J, Jamali GM, Makamba M, Mushati P, Chiyaka T, et al. Facilitators and barriers to engaging with the DREAMS initiative among young women who sell sex aged 18–24 in Zimbabwe: a qualitative study. BMC Womens Health. 2023;23(1):257.
Hargreaves JR, Mtetwa S, Davey C, Dirawo J, Chidiya S, Benedikt C, et al. Cohort analysis of programme data to estimate HIV incidence and uptake of HIV‐related services among female sex workers in Zimbabwe, 2009–14. J Acquir Immune Defic Syndr. 2015;72:e1–e8.
Jones HS, Hensen B, Musemburi S, Chinyanganya L, Takaruza A, Chabata ST, et al. Temporal trends in, and risk factors for, HIV seroconversion among female sex workers accessing Zimbabwe's national sex worker programme, 2009–19: a retrospective cohort analysis of routinely collected HIV testing data. Lancet HIV. 2023;10:e442–e452.
Jones A, Honermann B, Lankiewicz E, Sherwood J, Millett G. Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy. J Int AIDS Soc. 2021;24(S3):e25753.
Stevens O, Sabin K, Garcia SA, Anderson R, Willis K, Abdul‐Quader A, et al. Key population size, HIV prevalence, and ART coverage in sub‐Saharan Africa: systematic collation and synthesis of survey data. medRxiv. 2022. https://doi.org/10.1101/2022.07.27.22278071
Hargreaves J, Chabata S, Ali S, Hove T, Jones H, Bansi‐Matharu L, et al. Large decline in HIV prevalence among female sex workers in Zimbabwe, 2011–2023. Conference of Retroviruses and Opportunistic Infections; Denver; 2024.
Ali MS, Wit MDE, Chabata ST, Magutshwa S, Musemburi S, Dirawo J, et al. Estimation of HIV incidence from analysis of HIV prevalence patterns by age and years since starting sex work among female sex workers in Zimbabwe. AIDS. 2022;36:1141–1150.
Napierala S, Chabata ST, Fearon E, Davey C, Hargreaves J, Busza J, et al. Engagement in HIV care among young female sex workers in Zimbabwe. J Acquir Immune Defic Syndr. 2018;79(3):358–366.
Davey C, Dirawo J, Mushati P, Magutshwa S, Hargreaves JR, Cowan FM. Mobility and sex work: why, where, when? A typology of female‐sex‐worker mobility in Zimbabwe. Soc Sci Med. 2019;220:322–330.
Cowan FM, Mtetwa S, Davey C, Fearon E, Dirawo J, Wong‐Gruenwald R, et al. Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey. PLoS One. 2013;8(10):e77080.
Ndori‐Mharadze T, Fearon E, Busza J, Dirawo J, Musemburi S, Davey C, et al. Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015. J Int AIDS Soc. 2018;21(Suppl Suppl 5):e25138.
Cowan FM, Davey C, Fearon E, Mushati P, Dirawo J, Chabata S, et al. Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH‐IRe): a cluster‐randomised trial. Lancet HIV. 2018;5(8):e417–e426.
Evaluation of PEPFAR. Washington, DC: Institute of Medicine; 2013.
HIV/AIDS. JUNPo. IN DANGER: UNAIDS Global AIDS Update 2022. Geneva; 2022.
CROI Conference Proceedings. Seattle, WA: 2023. https://www.croiconference.org/abstract/cluster‐randomised‐trial‐of‐risk‐differentiated‐care‐for‐female‐sex‐workers‐amethist/