Background
Objectives
Research questions
Methods and design
Definition of FSW community-based service delivery
Definition of female sex work
Eligibility criteria for considering studies for review
Study participants and intervention
Outcomes
Search strategy
Search terms
Selection of eligible studies
Data extraction and management
Assessment of risk of bias
Data analysis
Results
Summary of key findings
Characteristics of included studies
(#Ref) Author (year) | Country | Study aim | Study design | Sample size and participant selection |
---|---|---|---|---|
[28] Aho et al. (2012) | Guinea | To describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea | Cross-sectional study | Randomly selected 421 at FSW at baseline and 223 at end line. Recruited through private or public centers providing adapted healthcare services (AHS) for FSWs |
[29] Chanda et al. (2017) | Zambia | To evaluate the effect of 2 different health system mechanisms (the active approach of peer-based HIV self-test) for HIV self-test delivery compared to referral to standard HIV testing | A 3-arm 1:1:1 cluster randomized trial | Total randomized per arm (320,316 and 329). Peer educator recruitment of social network via direct contact and referral |
[30] Cowan et al. (2019) | Zimbabwe | (i) To present the current impact that engagement in the Sisters program has on HIV incidence, prevalence, and control in FSW. (ii) To describe the patterns and characteristics of sex work among FSW in Zimbabwe (iii) To assess the potential for wider population impact of sex worker program by modelling the impact on HIV incidence of eliminating transmission through FSW | Cross-sectional study | Use of program data of 5083 FSW recruited through respondent-driven sampling surveys through three studies conducted in 19 sites: in 2011 to 2015; 2013 to 2016 and 2017 |
[31] Cowan et al. (2017) | Zimbabwe | To describe the HIV diagnosis and care cascade among FSW in Zimbabwe. | Cross-sectional study | Respondent-driven sampling surveys of FSW in 14 sites. Recruited 2722 women, approximately 200 per site as the baseline for a cluster-randomized controlled trial investigating a combination HIV prevention and care package. |
[32] Cowan et al. (2018) | Zimbabwe | To assess the efficacy of a targeted combination intervention for female sex workers in Zimbabwe. | Cluster-randomized trial from 2014 to 2016 | Randomly assigned 14 clusters (1:1) to receive usual care cluster (n = 3612) and an intervention cluster (n = 4619) |
[33] Huet et al. (2011) | Burkina Faso | To describe the long-term virological, immunological, and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women. | A prospective observational study nested within the Yerelon open cohort of high-risk women | 47 FSWs and 48 non-FSWs recruited through a network of peer educators and followed up at a dedicated clinic located within a public health facility. |
[34] Kelvin et al. (2019) | Kenya | To assess whether informing female sex workers about the availability of HIV self-testing at clinics in Kenya using text messages would increase HIV testing rates | Cohort study | A sample of 2196 female sex workers selected from electronic records. |
[35] Kerrigan et al. (2019) | Tanzania | To determine the impact of a community empowerment model of combination HIV prevention (Project Shikamana) among female sex workers (FSW) in Iringa, Tanzania. | A prospective community-randomized trial conducted in 2 communities matched on population size | Identified all active sex work venues (164 in total) in the 2 study communities and enrolled 496 FSW through a time-location sampling |
[36] Lafort et al. (2018) | South Africa, Mozambique, and Kenya | To enhance uptake of SRH services by FSWs through an implementation study | Cross-sectional study (in the context of an implementation research project) | 400 FSWs recruited by respondent-driven sampling |
[37] Lillie et al. (2019) | Burundi, Cote d’Ivoire, and DRC | To identify KP that had a new HIV diagnosis so that they could be linked to life-saving treatment for epidemic control | Quasi-experimental study | 929 FSWs sampled. Selection was done through distribution of coupons by peer |
[38] Lafort et al. (2016) | South Africa, Mozambique, and Kenya | To identify gaps in the use of HIV prevention and care services and commodities for female sex workers with the aim of improving SRH services. | Cross-sectional survey (in the context of an implementation research project) | Used RDS to recruit 400 sex worker in Durban, 308 in Tete, 400 in Mombasa, and 458 in Mysor |
[39] Luchters et al. (2008) | Kenya | To evaluate the impact of 5 years of peer-mediated STI/HIV prevention interventions among FSW in Mombasa, Kenya | Pre- and post- intervention cross-sectional surveys | Initial respondents (seeds) were identified from FSW work places, with subsequent participants recruited using snowball sampling. |
[40] Napierala et al. (2018) | Zimbabwe | (1) To compare engagement in services and the HIV care cascade among FSWs aged 18–24 years compared with those aged 25 years and older. (2) To explore factors associated with young FSWs’ engagement in HIV services. | Cross-sectional survey | Sampled 2722 FSW through respondent-driven sampling from 14 communities |
[41] Ndori-mharadze et al. (2018) | Zimbabwe | To compare key indicators related to FSW health-seeking behavior in 2011 and 2015 in three sites and explore whether observed differences might be linked to the delivery of intensified community mobilization. | Cross-sectional study | 870 FSW sampled in 2011 and 915 in 2015. FSWs were selected as seeds of the 2015 RDS survey, and also reviewed program data from the Sisters’ clinics between 2010 and 2015. |
[42] Pande et al. (2019) | Uganda | To assess preference and uptake of the current community-based HIV testing service delivery models that are used to reach FSW and identify challenges faced during the implementation of the models. | Cross-sectional study design | Used cluster sampling for hotspot selection and recruited 72 FSWs in each cluster |
[43] Schwartz et al. (2017) | South Africa | To assess engagement in the HIV care cascade and correlates of ART use among a sample of South African FSWs. | Cross-sectional study | Selection was done through RDS by selecting seeds to represent FSWs across ages, race, and locations |
[44] Tun et al. (2019) | Tanzania | To examine differences in treatment outcomes between the intervention and comparison arms. | Quasi-experimental prospective cohort study | 309 (intervention) and 308 (comparison) sampled at baseline. FSW selected randomly through community-based HTC in hotspots, directly contacting former Sauti FSWs and use of brochures |
[45] Vu et al. (2020) | Tanzania | To increase linkage to and retention in antiretroviral therapy (ART) care, by piloting a community based, ART service delivery intervention for female sex workers | Quasi-experimental prospective cohort study | 309 (intervention) and 308 (comparison) followed from baseline. FSW selected randomly through; community-based HTC in hotspots, directly contacting former Sauti FSWs and use of brochures |
Cascade step | Combined interventions that showed significant impact | Evidence |
---|---|---|
HIV testing | • Partnership with KP NGOs/CBOs based in the community/hotspots to deliver HTS services on behalf of national programs • Peer educator direct distribution of HIV self-test kits • Repeated use of text messaging and communication on what’s up by peers informing FSW about the availability of testing services in the community • Adapted health care: creation of FSW safe spaces and integration of targeted FSW HIV services in the general health care (e.g., STI screening and treatment, lubricants and condoms, direct escort by FSW peers within a public facility) • Provision of testing through night clinics (bars, brothels, DICs) • Full time provision of testing at clinics based in hotspots • Strengthening support networks FSW CSOs to encourage health-promoting behavior • Venue-based peer education, free condom distribution, and HIV counseling and testing; | Chanda et al. [29] Kelvin et al. [34] Aho et al. [28] Lafort et al. [38] Pande et al. [42] |
HIV diagnosis | Enhanced peer outreach approach: • Use of paid outreach peers that have not worked as peers before to find new FSWs from their network • Use of short-term incentivized peer support to reach their hard to reach contacts-FSWs | Lillie et al. [37] |
Linkage to care | None | |
ART use: | • NGO-initiated FSW-targeted mobile clinical services • Provision of services at a community-led drop-in center • Training of health workers in FSW-friendly approaches • Provision of HIV services in the community clinic by a professional health provider • Extending operating days at community based clinics with flex working hours • Provision of broad package of HIV service offered in clinics based in hotspots • Provision of on call services where FSW can consult anytime • Police sensitivity trainings, violence prevention, and campaigns for anti-stigma and discrimination | Kerrigan et al. [35] Pande et al. [42] |
Viral suppression | None | |
Interventions that showed a positive effect but with non-significant impact | ||
Linkage to | • Enhancing referral mechanisms to the neighboring public health facilities by paying stipend for peers. • Financial facilitation of FSW focal persons based at public health facilities • Establishment and incentivized peer referrals to the DICs • Creation of a safe space at a public health facility in a community without a FSW DIC • Conducting sensitivity trainings to all service providers including the non-professional staff within the clinics • Peer referrals and linkages at the clinics based in hotspots • Behavior change communication to educate and improve health-seeking behaviors • Extended hours of work to evenings, night, and weekends • Mobile HIV services to mitigate transport issues | Chanda et al. [29] Lafort et al. [36] |
Viral suppression: | • Usual HIV services augmented with additional community mobilization activities aimed at raising awareness of the benefits of ART. • Building leadership skills among FSW groups • Participation of FSW groups in selecting their fellow FSW adherence supporters • Adherence training sessions for the FSW adherence supporters • Mobile telephone messaging reminders for ART adherence • SMS and follow-up phone to support clinic attendance. • Empowering FSW to improve retention in care by targeting improved individual client-oriented practices | Cowan et al. [32] Kerrigan et al. [35] Napierala et al. [40] |
Risk of bias in included studies
The risk of bias in the included RCTs
The risk of bias assessment in cohort studies
The risk of bias for cross-sectional studies
HIV testing services
HIV diagnosis
Linkage to care
Use of antiretroviral therapy and retention in care
Viral suppression
Discussion
(#Ref) Author (year) | HIV testing | HIV diagnosis | Linkage to care | ART use | Viral suppression |
---|---|---|---|---|---|
[28] Aho et al. (2012) | √ | √ | |||
[29] Chanda et al. (2017) | √ | √ | √ | ||
[30] Cowan et al. (2019) | √ | √ | √ | √ | |
[32] Cowan et al. (2018) | √ | √ | √ | ||
[33] Huet et al. (2011) | √ | √ | √ | ||
[34] Kelvin et al. (2019) | √ | √ | |||
[35] Kerrigan et al. (2019) | √ | ||||
[36] Lafort et al. (2018) | √ | √ | √ | ||
[36] Lafort et al. (2018) | √ | √ | |||
[37] Lillie et al. (2019) | √ | √ | |||
[38] Lafort et al. (2016) | √ | √ | |||
[39] Luchters et al. (2008) | √ | ||||
[40] Napierala et al. (2018) | √ | √ | √ | √ | |
[47] Ndori-mharadze et al. (2018) | √ | √ | |||
[42] Pande et al. (2019) | √ | √ | √ | √ | |
[43] Schwartz et al. (2017) | √ | √ | √ | ||
[44] Tun et al. (2019) | √ | √ | |||
[45] Vu et al. (2020) | √ | √ |