Evaluating the vertical HIV transmission risks among South African female sex workers; have we forgotten PMTCT in their HIV programming?

• Published in: BMC public health 2019-05, Vol.19 (Suppl 1), p.605-605, Article 605
• Main Authors: Twahirwa Rwema, Jean Olivier, Baral, Stefan, Ketende, Sosthenes, Phaswana-Mafuya, Nancy, Lambert, Andrew, Kose, Zamakayise, Mcingana, Mfezi, Rao, Amrita, Hausler, Harry, Schwartz, Sheree
• Format: Article
• Language: English
• Subjects: Age; Antiretroviral therapy; Birth control; Breast feeding; Breastfeeding & lactation; Cascades; Children; Children & youth; Childrens health; Condoms; Confidence intervals; Contraceptives; Demographics; Demography; Disease prevention; Disease transmission; Families & family life; Family planning; Female sex workers; Health; Health aspects; Health care; Health risks; HIV; HIV infections; HIV patients; HIV tests; Human immunodeficiency virus; Infections; Information management; Maternal & child health; Medical tests; Occupational health; Pediatrics; Perinatal infection; PMTCT; Pregnancy; Prenatal care; Prevention; Prostitutes; Prostitution; Public health; Questionnaires; Reproductive health; Risk assessment; Risk factors; Seeds; Sex; Sex industry; Sex oriented businesses; Sexually transmitted diseases; Sociodemographics; South Africa; STD; Studies; Systematic review; Vertical transmission; Womens health; Workers; Working women
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-019-6811-4

Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children