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The issue
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.

Our approach
Project SOAR, Jhpiego, the National AIDS Control Programme, and National Institute for Medical Research are designing, implementing, and evaluating a community-based model of ART delivery to help mitigate these barriers. Specifically, HIV care and ART provision are being provided by clinicians at community-based HIV testing and counseling sites for FSWs, which also provide HIV prevention and sexual and reproductive health services. Using a mixed-method, quasi-experimental design, the study is assessing the effect of the intervention on HIV care and treatment outcomes, including ART initiation, retention, and viral suppression. We are following study participants and measuring biomedical, behavioral, and psychosocial outcomes at 6 and 12 months after enrollment. Additionally, we are collecting costing data to estimate the average annual ART-related cost per patient and exploring factors contributing to variations in treatment costs. Furthermore, we are assessing the feasibility of providing the same community ART service delivery model to HIV-positive children (ages 5 to 15 years old) under the care of the FSWs participating in the study as well as to a primary sex partner(s) identified by study participants.

The impact
Results will inform the Government of Tanzania, the National AIDS Control Programme, U. S. President’s Emergency Plan for AIDS Relief and other stakeholders about the effectiveness of ART delivery to FSWs and their families at the community level and the value of HIV service integration.