Hargreaves James R, Mtetwa Sibongile, Davey Calum, Dirawo Jeffrey, Chidiya Samson, Benedikt Clemens, Naperiela Mavedzenge Sue, Wong-Gruenwald Ramona, Hanisch Dagmar, Magure Tapiwa, Mugurungi Owen, Cowan Frances M
*Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, United Kingdom; †Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe; ‡United Nations Population Fund, New York, NY; §Women's Global Health Imperative, RTI International, San Francisco, CA; ‖Gesellschaft für Internationale Zusammenarbeit, Bonn, Germany; ¶National AIDS Council, Harare, Zimbabwe; #AIDS and TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe; and **Research Department for Infection and Population Health, University College London, London, United Kingdom.
J Acquir Immune Defic Syndr. 2016 May 1;72(1):e1-8. doi: 10.1097/QAI.0000000000000920.
HIV epidemiology and intervention uptake among female sex workers (FSW) in sub-Saharan Africa remain poorly understood. Data from outreach programs are a neglected resource.
Analysis of data from FSW consultations with Zimbabwe's National Sex Work program, 2009-2014. At each visit, data were collected on sociodemographic characteristics, HIV testing history, HIV tests conducted by the program and antiretroviral (ARV) history. Characteristics at first visit and longitudinal data on program engagement, repeat HIV testing, and HIV seroconversion were analyzed using a cohort approach.
Data were available for 13,360 women, 31,389 visits, 14,579 reported HIV tests, 2750 tests undertaken by the program, and 2387 reported ARV treatment initiations. At first visit, 72% of FSW had tested for HIV; 50% of these reported being HIV positive. Among HIV-positive women, 41% reported being on ARV. 56% of FSW attended the program only once. FSW who had not previously had an HIV-positive test had been tested within the last 6 months 27% of the time during follow-up. After testing HIV positive, women started on ARV at a rate of 23/100 person years of follow-up. Among those with 2 or more HIV tests, the HIV seroconversion rate was 9.8/100 person years of follow-up (95% confidence interval: 7.1 to 15.9).
Individual-level outreach program data can be used to estimate HIV incidence and intervention uptake among FSW in Zimbabwe. Current data suggest very high HIV prevalence and incidence among this group and help identify areas for program improvement. Further methodological validation is required.
撒哈拉以南非洲地区女性性工作者（FSW）中的艾滋病毒流行病学及干预措施的采用情况仍鲜为人知。外展项目的数据是一种被忽视的资源。
对2009 - 2014年津巴布韦全国性工作项目中FSW咨询数据进行分析。每次就诊时，收集社会人口学特征、艾滋病毒检测史、项目进行的艾滋病毒检测及抗逆转录病毒（ARV）治疗史等数据。采用队列研究方法分析首次就诊时的特征以及项目参与、重复艾滋病毒检测和艾滋病毒血清转化的纵向数据。
有13360名女性的数据，共31389次就诊，14579次报告的艾滋病毒检测，项目进行了2750次检测，2387次报告的ARV治疗起始情况。首次就诊时，72%的FSW进行过艾滋病毒检测；其中50%报告为艾滋病毒阳性。在艾滋病毒阳性女性中，41%报告正在接受ARV治疗。56%的FSW仅参加过一次该项目。之前艾滋病毒检测未呈阳性的FSW在随访期间有27%在过去6个月内进行过检测。艾滋病毒检测呈阳性后，女性开始接受ARV治疗的速率为每100人年随访23例。在进行过2次或更多次艾滋病毒检测的人群中，艾滋病毒血清转化率为每100人年随访9.8例（95%置信区间：7.1至15.9）。
个体层面的外展项目数据可用于估计津巴布韦FSW中的艾滋病毒发病率及干预措施的采用情况。当前数据表明该群体中艾滋病毒流行率和发病率非常高，并有助于确定项目改进的领域。还需要进一步的方法学验证。
