Female sex workers (FSWs) living with HIV face significant challenges in accessing HIV care and treatment services and, once started on antiretroviral treatment (ART), remaining in care and adhering to treatment. These challenges include difficulty in attending regular medical appointments because of time and cost constraints, providers’ stigmatizing attitudes, and poor service quality due to crowded ART clinics, long waiting times, and a lack of clinicians.
Project SOAR, in collaboration with the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project led by FHI 360, and the University of Malawi, College of Medicine, are investigating the feasibility, acceptability, and effects of a community-based ART service delivery model using FSW-friendly drop-in-centers. This is a cohort study in which we will recruit approximately 200 FSWs living with HIV in the cities of Lilongwe and Mzuzu through LINKAGES HIV testing and counseling community outreach activities (mainly through “moonlight” testing events).
FSW cohort participants will have the opportunity to choose one of two types of ART services to attend: (a) LINKAGES-supported, community-based drop-in centers operated by Pakachere or (b) mainstream government facilities in the catchment areas. Behavioral, psychosocial, and treatment-related outcomes will be measured at baseline and again after a 12-month period. Viral load measurements will be extracted from clinic records at 12 months. Qualitative interviews will be conducted at 12 months with a subsample of FSW cohort participants and intervention service providers to assess fidelity, acceptability, challenges, and successes of the community-based drop-in centers.
This study will generate and disseminate evidence of effective strategies to link and retain HIV-positive FSWs in care and treatment. Such evidence will help inform the government’s and U. S. President’s Emergency Plan for AIDS Relief’s strategy in Malawi.