Longitudinal trajectories of engagement with HIV treatment support strategies among female sex workers living with HIV in South Africa

dc.contributor.authorComins, Carly A.
dc.contributor.authorGenberg, Becky L.
dc.contributor.authorMcIngana, Mfezi
dc.contributor.authorBandeen-Roche, Karen Bandeen
dc.contributor.authorPhetlhu, René Deliwe
dc.contributor.authorSteingo, Joel
dc.contributor.authorMishra, Sharmistha
dc.contributor.authorWang, Linwei
dc.contributor.authorBaral, Stefan David
dc.contributor.authorHausler, Harry
dc.contributor.authorSchwartz, Sheree
dc.date.accessioned2025-09-03T12:42:39Z
dc.date.issued2025
dc.description.abstractBACKGROUND : Tailored implementation strategies to promote the uptake and scale-up of antiretroviral therapy (ART) among female sex workers (FSW) in South Africa are needed, as <50% of FSW living with HIV are on ART and <40% are virally suppressed. SETTING : We conducted a randomized trial testing two HIV treatment support strategies (decentralized treatment provision (DTP); individualized case management (ICM)) among 777 FSW living with HIV and not virally suppressed (≥50 copies/mL) in Durban, South Africa, June 2018 - January 2022. METHODS : We defined strategy engagement in a six-month interval if the monthly strategy session was delivered and the FSW participated. Group-based trajectory modeling with logit response function was used to identify engagement trajectories and describe correlates of trajectories. We used Poisson regression analysis with robust variance estimation to assess the association between assigned trajectory group and 18-month retention and viral suppression (<50 copies/mL). RESULTS : We identified four trajectories: no engagement (12%), late engagement (10%), engagement corresponding with study visits (53%), and consistent engagement (25%). FSW who were older, unmarried, receiving ART at enrollment, and DTP assignment were more likely to be classified in the consistently engaged trajectory compared to the no engagement trajectory. The prevalence of 18-month retention and viral suppression was higher among FSW assigned to the consistent engagement trajectory compared to the no engagement trajectory (prevalence ratio [PR]= 3.2, 95%CI 1.6-6.3). CONCLUSION : Person-centered HIV services that address unmet treatment needs could improve health, viral suppression, and subsequently reduce population-level HIV transmission.
dc.description.departmentFamily Medicine
dc.description.embargo2026-08-14
dc.description.librarianhj2025
dc.description.sdgSDG-03: Good health and well-being
dc.description.sponsorshipThe National Institute of Nursing Research, the National Institute of Mental Health and support from the Johns Hopkins University Center for AIDS Research.
dc.identifier.citationComins, C.A., Genberg, B.L., McIngana, M. et al. 2025, 'Longitudinal trajectories of engagement with HIV treatment support strategies among female sex workers living with HIV in South Africa Journal of Acquired Immune Deficiency Syndromes, doi : 10.1097/QAI.0000000000003738.
dc.identifier.issn1525-4135 (print)
dc.identifier.issn1077-9450 (online)
dc.identifier.other10.1097/QAI.0000000000003738
dc.identifier.urihttp://hdl.handle.net/2263/104190
dc.language.isoen
dc.publisherLippincott, Williams & Wilkins
dc.rights© 2025 Wolters Kluwer Health, Inc. All rights reserved.
dc.subjectAntiretroviral therapy (ART)
dc.subjectFemale sex workers (FSW)
dc.subjectSouth Africa (SA)
dc.subjectHuman immunodeficiency virus (HIV)
dc.subjectHIV treatment
dc.subjectImplementation science
dc.subjectGroup-based trajectory modeling
dc.titleLongitudinal trajectories of engagement with HIV treatment support strategies among female sex workers living with HIV in South Africa
dc.typePostprint Article

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