The HIV care cascade among female sex workers in Zimbabwe: results of a population-based survey from the Sisters Antiretroviral therapy Programme for Prevention of HIV, an Integrated Response (SAPPH-IRe) Trial

Introduction: Female sex workers (FSW) in sub-Saharan Africa have a higher prevalence of HIV than other women of reproductive age. Social, legal, and structural barriers influence their access to care. Little is known about the HIV diagnosis and care cascade in most countries in southern Africa. We aimed to describe the HIV diagnosis and care cascade among FSW in Zimbabwe.

Methods: We conducted cross-sectional respondent driven sampling (RDS) surveys of FSW in 14 sites across Zimbabwe as the baseline for a cluster-randomised controlled trial investigating a combination HIV prevention and care package. We administered a questionnaire, tested women for HIV and measured viral load. We report the mean, minimum and maximum RDS-2 weighted site values.

Results: The survey included 2,722 women, approximately 200 per site. The mean HIV prevalence was 57.5% (42.8-79.2 site minimum and maximum). Of HIV positive women, 64.0% (51.6-73.7) were aware of their status, 67.7% (53.4-84.1) of these reported taking ART and 77.8% (64.4-90.8) of these had a suppressed HIV viral load (<1000 copies/ml). Among all HIV positive women, 49.5% had a viral load < 1000 copies/ml.

Conclusions: While the majority of HIV positive women aware of their status are accessing ART, 36.0% of HIV positive women are unaware of their status and 29.3% of all FSW have an unsuppressed HIV viral load. Investigation and investment into models of testing, treatment and care are necessary to reach UNAIDS targets for HIV elimination.