USAID MULU: Key Populations Activity: Factors associated with newly diagnosed HIV infection among female sex workers (FSW)

Background: The USAID MULU Key Populations Activity has been implementing HIV prevention project targeting female sex workers (FSWs) through Drop-in Centers (DICs) and outreach services since 2018. FSWs in Ethiopia are disproportionately impacted by HIV, with a prevalence of 23% compared to a national prevalence of 0.9%. To reach the remaining FSWs with undiagnosed infectionswe used index case testing (ICT) for sexual partner and respondent-driven testing (RDT) for social networks of HIV+ to offer HIV testing service The objective of this analysis was to identify factors associated with newly diagnosed HIV infection among FSWs in the community. 

Methods: We used program data from all implementation sites in the Amhara region and Addis Ababa City from October 2018-December 2019. We assessed new HIV positivity outcomes (number of new positives, and yield [proportion of all those tested who were new positives]) by testing approach (ICT vs RDT), age, HIV testing history, and region. Multiple logistic regression analysis was used to identify variables associated with identifying undiagnosed FSW living with HIV  

ResultsA total of 23,600 FSW were tested during the reporting period. Of these, 1,582 (6.7%) were tested through ICT, and 411 (26% yield) were diagnosed with HIV. In comparison 22,018 (93.3%) were tested through RDT, and 793 (3.6% yield) were diagnosed with HIV. A total of 1,204 cases (5.1% yield) were newly diagnosed with HIV. The odds of testing positive among FSWs was 9 times higher among FSWs tested through ICT compared to RDT (AOR=9; 95%CI=8.1-10.5). The odds of testing positive among FSWs who tested for the first time was 1.4 times higher compared to those with prior testing (AOR=1.4; 95%CI=1.2-1.6). There was no statistically significant relationship between age and region with HIV diagnosis. Linkage to HIV care and treatment within 90 days was 93%, but lower among FSW tested at outreach (90%) compared with those tested at DIC (95%).  

Conclusions: ICT is an effective case finding approach and the volume of tests should be expanded to result in better case finding. The program should focus on FSWs who have never tested for HIV