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Becker M, Mishra S, Bhattacharjee P, Musyoki H, Tennakoon A, Leung S, Cheuk E, Lorway R, Isac S, Ma H, Cholette F, Sandstrom P, Gichangi P, Mwatelah R, Mckinnon L, Blanchard J, Pickles M. Differential Burden of HIV Among Adolescent Girls and Young Women by Places Associated With Sex Work: An Observational Study in Mombasa, Kenya. J Acquir Immune Defic Syndr 2024; 96:121-129. [PMID: 38771751 DOI: 10.1097/qai.0000000000003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/02/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work (SW) programs but could be used to reach other AGYW at high risk. SETTING This study took place in Mombasa, Kenya. METHODS We conducted a cross-sectional, bio-behavioural survey among (N = 1193) sexually active AGYW aged 14-24 years recruited at hotspots. We compared HIV prevalence by subgroup (SW; transactional sex, TS; and non-transactional sex), stratified by hotspot type (venues and nonvenues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio with and without adjustment for these individual-level factors. RESULTS Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in nonvenues. Overall SW HIV prevalence was 2-fold higher than among participants engaged in nontransactional sex. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% confidence interval: 1.56 to 4.85) and 2.11 times higher among nonvenue AGYW not engaged in SW (95% confidence interval: 0.97 to 4.30) compared with venue-based AGYW not engaged in SW. CONCLUSION AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a "place" to reach AGYW at high risk of HIV.
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Affiliation(s)
- Marissa Becker
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Aruni Tennakoon
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stella Leung
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Eve Cheuk
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Lorway
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- India Health Action Trust, New Delhi, India
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | | | - Ruth Mwatelah
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lyle Mckinnon
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya; and
| | - James Blanchard
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Sanchez-Gendriz I, Carvalho DDA, Galvão-Lima LJ, Sales-Moioli AIL, Brito T, Fernandes F, Henriques J, Lima T, Guedes LA, Cruz AS, Morais AHF, Santos JPQ, Arrais E, Coutinho KD, Machado GM, Cunha-Oliveira A, Dos Reis Vale Gomes CA, Valentim RAM. Digital dual test syphilis/HIV detection based on Fourier Descriptors of Cyclic Voltammetry curves. Comput Biol Med 2024; 174:108454. [PMID: 38608326 DOI: 10.1016/j.compbiomed.2024.108454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/10/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Effective and timely detection is vital for mitigating the severe impacts of Sexually Transmitted Infections (STI), including syphilis and HIV. Cyclic Voltammetry (CV) sensors have shown promise as diagnostic tools for these STI, offering a pathway towards cost-effective solutions in primary health care settings. OBJECTIVE This study aims to pioneer the use of Fourier Descriptors (FDs) in analyzing CV curves as 2D closed contours, targeting the simultaneous detection of syphilis and HIV. METHODS Raw CV signals are filtered, resampled, and transformed into 2D closed contours for FD extraction. Essential shape characteristics are captured through selected coefficients. A complementary geometrical analysis further extracts features like curve areas and principal axes lengths from CV curves. A Mahalanobis Distance Classifier is employed for differentiation between patient and control groups. RESULTS The evaluation of the proposed method revealed promising results with classification performance metrics such as Accuracy and F1-Score consistently achieving values rounded to 0.95 for syphilis and 0.90 for HIV. These results underscore the potential efficacy of the proposed approach in differentiating between patient and control samples for STI detection. CONCLUSION By integrating principles from biosensors, signal processing, image processing, machine learning, and medical diagnostics, this study presents a comprehensive approach to enhance the detection of both syphilis and HIV. This setts the stage for advanced and accessible STI diagnostic solutions.
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Affiliation(s)
- Ignacio Sanchez-Gendriz
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil.
| | - Dionísio D A Carvalho
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Leonardo J Galvão-Lima
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Ana Isabela Lopes Sales-Moioli
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Talita Brito
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Felipe Fernandes
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Jorge Henriques
- Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - Thaisa Lima
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Ministry of Health, Esplanada dos Ministérios, Brasília, Brazil
| | - Luiz Affonso Guedes
- Department of Computer Engineering and Automation, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Agnaldo S Cruz
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Antonio H F Morais
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal/RN, Brazil
| | - João Paulo Q Santos
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal/RN, Brazil
| | - Ernano Arrais
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Karilany Dantas Coutinho
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | | | - Aliete Cunha-Oliveira
- Health Sciences Research Unit, Nursing (UICISA: E) and Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Center for Interdisciplinary Studies - CEIS20, University of Coimbra, Coimbra, Portugal
| | | | - Ricardo A M Valentim
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
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Mpirirwe R, Segawa I, Ojiambo KO, Kamacooko O, Nangendo J, Semitala FC, Kyambadde P, Kalyango JN, Kiragga A, Karamagi C, Katahoire A, Kamya M, Mujugira A. HIV pre-exposure prophylaxis uptake, retention and adherence among female sex workers in sub-Saharan Africa: a systematic review. BMJ Open 2024; 14:e076545. [PMID: 38670600 PMCID: PMC11057315 DOI: 10.1136/bmjopen-2023-076545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To evaluate oral pre-exposure prophylaxis (PrEP) uptake, retention and adherence among female sex workers (FSWs) receiving care through community and facility delivery models in sub-Saharan Africa (SSA). DESIGN Systematic review and meta-analysis. DATA SOURCES We searched online databases (PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews and Web of Science) between January 2012 and 3 April 2022. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials, cohort studies, cross-sectional studies and quasi-experimental studies with PrEP uptake, adherence and retention outcomes among FSWs in SSA. DATA EXTRACTION AND SYNTHESIS Seven coders extracted data. The framework of the Cochrane Consumers and Communication Review Group guided data synthesis. The Risk of Bias In Non-Randomized Studies of Interventions tool was used to evaluate the risk of bias. Meta-analysis was conducted using a random-effects model. A narrative synthesis was performed to analyse the primary outcomes of PrEP uptake, adherence and retention. RESULTS Of 8538 records evaluated, 23 studies with 40 669 FSWs were included in this analysis. The pooled proportion of FSWs initiating PrEP was 70% (95% CI: 56% to 85%) in studies that reported on facility-based models and 49% (95% CI: 10% to 87%) in community-based models. At 6 months, the pooled proportion of FSWs retained was 66% (95% CI: 15% to 100%) for facility-based models and 83% (95% CI: 75% to 91%) for community-based models. Factors associated with increased PrEP uptake were visiting a sex worker programme (adjusted OR (aOR) 2.92; 95% CI: 1.91 to 4.46), having ≥10 clients per day (aOR 1.71; 95% CI: 1.06 to 2.76) and lack of access to free healthcare in government-run health clinics (relative risk: 1.16; 95% CI: 1.06 to 1.26). CONCLUSIONS A hybrid approach incorporating both facility-based strategies for increasing uptake and community-based strategies for improving retention and adherence may effectively improve PrEP coverage among FSWs. PROSPERO REGISTRATION NUMBER CRD42020219363.
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Affiliation(s)
- Ruth Mpirirwe
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Segawa
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | | | - Joan N Kalyango
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- College of Health Sciences, Makerere University, Kampala, Uganda
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Wariso FB, Ayalew J, Barba A, Bedassa BB, Ebo GG, Tura JB, Rameto M, Belihu WB, Asfaw D, Amogne MD, Negeri L, Lulseged S, Abrahim SA. Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach. Front Public Health 2023; 11:1190085. [PMID: 37601188 PMCID: PMC10437068 DOI: 10.3389/fpubh.2023.1190085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Background Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia. Methods A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p-value of ≤0.05 was used as a threshold for statistical significance. Results At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs. Conclusion STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis.
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Affiliation(s)
| | - Jemal Ayalew
- College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Ammar Barba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Lemessa Negeri
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Truong HHM, Fatch R, Ogolla D, Otieno B, Amboka S, Kadede K, Cohen CR, Bukusi EA, Guzé MA. Respondent-driven sampling to recruit adolescents in Kenya. Ann Epidemiol 2023; 78:68-73. [PMID: 36509343 PMCID: PMC10789922 DOI: 10.1016/j.annepidem.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/21/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Respondent-driven sampling (RDS) uses long-chain referral whereby members of the target population recruit other members. We describe the use of RDS for a mixed-methods sexual and reproductive health (SRH) study in Kisumu, Kenya. METHODS Initial seeds for the cross-sectional surveys were selected from adolescents aged 15-19 residing in urban informal settlements. Participants were provided up to five referral coupons to distribute. RESULTS Across four communities, 18 seeds were selected, 13,489 coupons distributed, and 3381 adolescents referred, yielding a 25% coupon return rate. We enrolled 3061 participants for a 23% survey rate. Median referral lag time was three days (IQR 1, 7). Demographic characteristics reached equilibrium between recruitment waves 5 to 8 in three communities, and waves 7 to 15 in the fourth. CONCLUSIONS Our study demonstrated that RDS is a feasible and efficient approach for recruiting a large sample of adolescents. Though our research focused on SRH, many adolescents residing in the impoverished urban environments where our study was implemented also experience food insecurity, housing instability and violence. RDS can therefore be a valuable recruitment approach for future studies to reach vulnerable adolescents and design interventions that address the variety of health-related challenges that affect this underserved population.
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Affiliation(s)
- Hong-Ha M Truong
- University of California San Francisco, San Francisco, California, USA.
| | - Robin Fatch
- University of California San Francisco, San Francisco, California, USA
| | | | | | - Sayo Amboka
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Craig R Cohen
- University of California San Francisco, San Francisco, California, USA
| | | | - Mary A Guzé
- University of California San Francisco, San Francisco, California, USA
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Ngo A, Nguyen VT, Phan H, Pham V, Ngo C, Nguyen L, Ha T. Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam. Mhealth 2023; 9:3. [PMID: 36760784 PMCID: PMC9902234 DOI: 10.21037/mhealth-22-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. METHODS iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. RESULTS There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). CONCLUSIONS The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.
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Affiliation(s)
- Anh Ngo
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Thi Nguyen
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Ha Phan
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Pham
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Cuong Ngo
- US News and World Report, Washington, DC, USA
| | | | - Toan Ha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
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Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Bitty-Anderson AM, Gbeasor-Komlanvi FA, Bakoubayi AW, Tchankoni MK, Sadio AJ, Salou M, Dagnra CA, Ekouevi DK, Coffie PA. High burden of self-reported sexually transmitted infections among female sex workers in Togo in 2021. Front Public Health 2022; 10:915029. [PMID: 35991055 PMCID: PMC9381961 DOI: 10.3389/fpubh.2022.915029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sexually Transmitted Infections (STI) remain a public health challenge, especially for Female Sex Workers (FSW) who are particularly vulnerable. In sub-Saharan Africa where the overlapping epidemics of STI and HIV are concentrated among key populations, epidemiological data are needed in order to better understand STI trends in this population. The aim of this study was to assess the prevalence of self-reported STI symptoms and their risk factors among FSW in Togo in 2021. Methods A cross-sectional study was completed in June and July 2021 among FSW in two cities of Togo: in Lomé (capital city, south of Togo) and in Kara (north of Togo). A snowball sampling method was used and after consent, a standardized questionnaire was administered by trained research staff to collect information on STI. A multivariate logistic regression model was used to identify factors associated with self-reported STI. Results A total of 447 FSW, 300 in Lomé and 147 in Kara participated in this study. Median age was 30 [IQR: 24–38] and STI symptoms in the previous 12 months were reported by 191 FSW [42.7%, 95% CI: (38.1–47.5)], among whom 116 (60.7%) sought medical care. The most common reported symptoms were abnormal vaginal discharge (n = 78; 67.2%) and vaginal itching (n = 68; 58.6%). Current STI symptoms (at the time of the survey) were reported by 88 FSW (19.7%). In multivariable logistic regression, self-reported STI symptoms in the previous 12 months was negatively associated with living in the Lomé and older age and positively associated with having more than 15 clients in the previous week and being victim of violence. Conclusions Findings from this study reveal that the self-reported STI burden is relatively high among FSW Togo. Additional strategies are needed at the structural, medical, political and social levels to curb this trend and effectively aim at the elimination of STI epidemics by the year 2030.
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Affiliation(s)
- Alexandra M. Bitty-Anderson
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- PAC-CI Research Center – ANRS Site Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire
- *Correspondence: Alexandra M. Bitty-Anderson
| | - Fifonsi A. Gbeasor-Komlanvi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Akila W. Bakoubayi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Martin K. Tchankoni
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
| | - Arnold J. Sadio
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Mounerou Salou
- Molecular Biology Laboratory, Fundamental Sciences Department, University of Lomé, Lomé, Togo
- National HIV/AIDS, Viral Hepatitis and Sexually Transmitted Infections Program (PNLS/HV/IST), Lomé, Togo
- Laboratory Services, University Hospital Campus (CHU Campus), Lomé, Togo
| | - Claver A. Dagnra
- Molecular Biology Laboratory, Fundamental Sciences Department, University of Lomé, Lomé, Togo
- National HIV/AIDS, Viral Hepatitis and Sexually Transmitted Infections Program (PNLS/HV/IST), Lomé, Togo
| | - Didier K. Ekouevi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Patrick A. Coffie
- PAC-CI Research Center – ANRS Site Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire
- Medical Sciences Research and Formation Unit, Dermatology and Infectiology Department, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- University Hospital of Treichville, Infectious and Tropical Diseases Service, Abidjan, Côte d'Ivoire
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9
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Bitty-Anderson AM, Gbeasor-Komlanvi FA, Tchankoni MK, Sadio A, Salou M, Coffie PA, Dagnra CA, Ekouevi DK. HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study. Arch Public Health 2022; 80:92. [PMID: 35331303 PMCID: PMC8943989 DOI: 10.1186/s13690-022-00851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The HIV epidemic remains an important public health challenge for the sub-Saharan region. Female Sex Workers (FSW) in this region are among the most vulnerable of the key population groups with HIV prevalence as high as twice that of the general population. The aim of this study was to estimate HIV prevalence and explore sexual risk behaviors among FSW in Togo. Methods A cross-sectional study using a Respondent Driven Sampling method was conducted across the six regions of country among FSW in 2017. A comprehensive questionnaire was used to explore socio-demographic characteristics, sexual history, HIV knowledge, and sexual behaviors. HIV rapid tests were used to assess HIV infection. Results A total of 1,036 FSW, with a median age of 26 years old [interquartile range (IQR): 22–33], participated in the study, with 49.2% (n = 510) of them having reached secondary school. Median age at first sexual intercourse was 20 years old [IQR: 17–25] and estimated number of clients per week was of 5 [IQR: 3–10]. A total of 936 (95.6%) reported the use of a condom during last sexual intercourse with a client and 493 (47.6%) reported the use of a condom during their last sexual intercourse with a partner or husband. HIV prevalence was 13.2% [95% CI: 11.2 – 15.4], and was associated with age (being between 26 and 32 years old; aOR = 4.5; 95% CI: [2.4 – 9.1], p < 0.0001) and ≥ 33 years old; aOR = 6.4; 95% CI [3.5 – 12.7], p < 0.0001), education level (being in primary school or less; aOR = 1.7; 95% CI: [1.1–2.6]; p = 0.012) and the number of partners per week (more than 2 and 3 partners; aOR = 2.5; 95% CI [1.2—5.2]; p = 0.014). Conclusions HIV prevalence and sexual risk behaviors remain high among FSW in Togo, despite prevention efforts aimed at curbing this trend. Other factors, such as access and availability of condoms, the social and legal environment in which FSW operate, should be considered for HIV prevention strategies in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00851-0.
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Affiliation(s)
- Alexandra M Bitty-Anderson
- Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.,INSERM U1219, Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.,Programme PACCI - Site ANRS Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Fifonsi A Gbeasor-Komlanvi
- Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.,Département de santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Martin Kouame Tchankoni
- Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.,Département de santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Arnold Sadio
- Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.,Département de santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Mounerou Salou
- Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire, Université de Lomé, Lomé, Togo
| | - Patrick A Coffie
- Programme PACCI - Site ANRS Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire.,Département de Dermatologie et d'Infectiologie, Université Félix Houphouët Boigny, UFR des Sciences Médicales, Abidjan, Côte d'Ivoire.,CHU de Treichville, Service de Maladies Infectieuses et Tropicales, Abidjan, Côte d'Ivoire
| | - Claver A Dagnra
- Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire, Université de Lomé, Lomé, Togo.,Programme National de Lutte contre le VIH/Sida, les Hépatites virales et les Infections Sexuellement Transmissibles (PNLS/HV/IST), Lomé, Togo
| | - Didier K Ekouevi
- Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo. .,INSERM U1219, Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France. .,Département de santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
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10
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Govender RD, Hashim MJ, Khan MAB, Mustafa H, Khan G. Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe. J Epidemiol Glob Health 2021; 11:296-301. [PMID: 34270183 PMCID: PMC8435868 DOI: 10.2991/jegh.k.210621.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/21/2021] [Indexed: 12/02/2022] Open
Abstract
We aimed to assess global trends in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and evaluate progress toward eradication since the inception of the pandemic. Data were extracted from the Global Burden of Disease 2019 update and the UNAIDS Data 2019. The datasets included annual figures from 1990 to 2019 for HIV/AIDS in 204 countries and all world regions. We analyzed rates and trends for prevalence, incidence, mortality and disability adjusted life years. Analysis of age and gender distribution in different regions was used to assess demographic changes. Forecasting was used to estimate disease burden up to 2040. Although many countries have witnessed a decrease in the incidence, for Russia, Ukraine, Portugal, Brazil, Spain and the United States, the rates of new cases are rising since 2010. This trend is present even in age-standardized analysis, indicating a rise in excess of population growth. Over 0.5% of the world's population is infected. About 5000 new infections occur daily, of which 500 are children. Mortality rates are falling globally; currently at 11 deaths per 100,000 population, forecasted to decrease to 8.5 deaths by 2040. Prevalence continues to increase, with South Africa, Nigeria, Mozambique, India, Kenya and the United States having the highest burden. The total number as well as the rates of new HIV infections are rising every year in Europe, South America, North America and other regions over the last decade. Maternal-to-child transmission continues at high rates despite effective preventive regimens. There is an urgent need to develop programs to curb the rising incidence of HIV.
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Affiliation(s)
- Romona D. Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain 17666, UAE
| | - Muhammad Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain 17666, UAE
| | - Moien AB Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain 17666, UAE
| | - Halla Mustafa
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain 17666, UAE
| | - Gulfaraz Khan
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain 17666, UAE
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