HIV treatment response among female sex workers participating in a treatment as prevention demonstration project in Cotonou, Benin


Autoři: Mamadou Diallo aff001;  Luc Béhanzin aff002;  Fernand A. Guédou aff002;  Nassirou Geraldo aff003;  Ella Goma-Matsétsé aff003;  Dramane Kania aff005;  René Kpèmahouton Kêkê aff006;  Moussa Bachabi aff006;  Dissou Affolabi aff007;  Souleymane Diabaté aff001;  Flore Gangbo aff006;  Marcel Djimon Zannou aff007;  Michel Alary aff001
Působiště autorů: Département de médecine sociale et préventive, Université Laval, Québec aff001;  Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada aff002;  Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin aff003;  Ecole Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Bénin aff004;  National Reference Laboratory of Viral Hemorrhagic Fever Centre MURAZ, Bobo-Dioulasso, Burkina Faso aff005;  Programme Santé de Lutte contre le Sida (PSLS), Cotonou, Bénin aff006;  Centre national hospitalier universitaire HMK de Cotonou, Bénin aff007;  Faculté des sciences de la santé, Université d’Abomey-Calavi, Cotonou, Bénin aff008;  Université Alassane Ouattara, Bouaké, Côte d’Ivoire aff009;  Institut national de santé publique du Québec, Québec, Canada aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227184

Souhrn

Objectives

Female sex workers (FSWs) play a key role in HIV transmission in West Africa, while they have limited access to antiretroviral therapy (ART). In line with UNAIDS recommendations extending ART to all HIV-infected individuals, we conducted this demonstration project on immediate treatment as prevention (TasP) among FSWs in Cotonou, Benin. We report data on treatment response and its relation to adherence, as well as on ART-resistant genotypes.

Methods

Complete follow-up varied between 12 and 24 months. At each three-monthly visit, a questionnaire was administered, clinical examinations were carried out and blood samples collected. Adherence to treatment was estimated by self-report. Viral RNA was genotyped at baseline and final visits for drug resistance. Generalized estimating equations for repeated measures with a log-binomial link were used to analyze time trends and the association between adherence and virological response to treatment.

Results

One-hundred-seven HIV-positive and ART-naive FSWs were enrolled; 59.8% remained in the cohort till study completion and 62.6% had a final visit. Viral load<1000 (below quantification limit [<50]) was attained in 73.1% (64.6%) of participants at month-6, 84.8% (71.2%) at month-12, and 80.9% (65.1%) at the final visit. The proportion of women with suppressed (below quantification limit) viral load increased with increasing self-reported adherence (p = 0.06 (0.003), tests for trend). The proportion of participants with CD4≤500 also decreased drastically throughout follow-up (p < .0001). Twelve participants exhibited ART-resistant genotypes at baseline, but only two at their final visit.

Conclusion

Our findings indicate that TasP is widely accepted among FSWs in Cotonou and could be implemented with relative success. However, due to mobility in this population, follow-up was sub-optimal, suggesting that large geographical coverage of FSW-friendly clinics is needed for sustained treatment implementation. We also fell short of the UNAIDS objective of 90% viral suppression among treated patients, underlining the need for better adherence support programs.

Klíčová slova:

Antimicrobial resistance – Antiretroviral therapy – Benin – Female sex workers – HIV epidemiology – HIV prevention – Sex work – Viral load


Zdroje

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